Chicago Health Alert Network

Pain Management

Pain Management Guidelines/Recommendations:

American College of Emergency Physicians’ Clinical Policy on Opioid Prescribing

ADA Statement on the Use of Opioids in the Treatment of Dental Pain 

CDC Guideline for Prescribing Opioids for Chronic Pain

VA Management of Opioid Therapy for Chronic Pain  (2017)

“Opioid Stewardship and Chronic Pain: A Guide For Primary Care Providers”  (California Department of Public Health)

Pain Management Clinical Tools:

·        CDC Clinical Tools 

·        Online Morphine Milligram Equivalent Calculator  : 

·        Illinois Perscription Monitoring Program   

·        Opioid Risk Tool

·        PEG Pain Scale Monitoring Tool 

Online Continuing Medical Education (Free):

·        PCSS-O Core Curriculum on Opioid Management  

·        PCSS-O Additional Archived CME 

·        Applying CDC’s Guidelines for Prescribing Opioids 

·        CDC’s treating chronic pain without opioids  

Please click the links below to access to Presentations from the February 13, 2018 conference "Opioid Stewardship and Managing the Opioid Crisis: A Health-Care Perspective"

DSM 5 OUD Diagnostic Criteria

Recent New England Journal of Medicine Article describing opioid use disorder treatment

Best Practices Related to Opioids for Emergency Departments

Medication Assisted Treatment (MAT) OUD Treatment Guidelines

• American Society of Addiction Medicine National Practice Guideline for the use of Medications in the Treatment of Addiction Involving Opioid Use
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• Substance Abuse and Mental Health Services Administration (SAMHSA) Medication Assisted Treatment Guide

OUD online CME:

• PCSS-MAT Medication Assisted Treatment (MAT) basics
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• Buprenorphine Trainings: Buprenorphine is a medication that is FDA-approved for treatment of opioid use disorder.  To be able to prescribe buprenorphine, a prescriber must complete additional training.  Physicians have to complete 8 hours of training (available online) and Nurse Practitioners and Physicians Assistants must complete the same 8 hour training with an additional 16 hours of training (for a total of 24 hours).  Upon completion of this training, a prescriber must apply for a waiver to be allowed to prescribe the medication. The waiver application can be found here: http://buprenorphine.samhsa.gov/forms/select-practitioner-type.php
  • List of Providers for Buprenorphine 8 hour Training   
  • Additional 16 hour buprenorphine trainings (For NPs and PAs) 
  • SAMHSA Treatment Finder (lists behavioral health treatment services) 
  • Bup Practice:  Offers many resources for buprenorphine prescribers

If you are interested in attending a free CDPH - sponsored buprenorphine training, please contact Gabrielle Nicohols via email at Gabrielle.Nichols@cityofchicago.org.

Harm Reduction and Overdose Prevention:

• Encourage patients (and their family and friends) to carry naloxone:
  • Any licensed prescriber can write a prescription for naloxone, which patients can fill in a pharmacy. Any licensed prescriber can also write a prescription for naloxone for friends and family of a patient who is using opioids.  For more information, click here.  or contact: Elizabeth.salisburyafshar@cityofchicago.org.  **Because of the increase in fentanyl and analogs, you may want to consider prescribing 3 units of naloxone instead of the standard two units*
    • To watch a video on how to talk to patients about naloxone in primary care and pain management settings, go here.
  • Per Illinois law, a pharmacist who has completed training can initiate naloxone dispensing without a physician prescription.  The same Illinois law requires that all Medicaid plans must provide coverage for naloxone.  To date, Walgreens has trained all of its pharmacists in Illinois to be able to do this.  Many other individual and chain pharmacies have trained some pharmacists.
  • Overdose response education and naloxone distribution is also available through the Chicago Recovery Alliance (CRA).  A schedule for the CRA mobile van can be found here.
  • Patient videos of how to administer naloxone can be found here.
  • Patient handout on how to administer naloxone can be found here and here.  (Two handouts for patients)

• Educate patients (and their family and friends) on harm reduction techniques to avoid overdose and death:
  • Avoid using drugs alone
  • Know your limits- do a “test shot” to see how strong the drug is (i.e., inject or snort a smaller amount than usual to make sure that the response is as expected)
  • Avoid mixing drugs when possible, especially multiple “downers” that can cause respiratory depression
  • Carry an overdose rescue kit (naloxone) and be sure others know you have it
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• Encourage patients and families to check out the CDPH website: "Overcome Opioids" (www.overcomeopioids.org) which includes general information and local resources.
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• Talk to patients about their readiness to engage in treatment: 
  • Let them know that Medication Assisted Treatment (MAT) has good outcomes for people with opioid use disorder.  Methadone, buprenorphine, and extended release injectable naltrexone are all FDA approved medications for opioid use disorder.
  • If patients express interest but are not sure where they can go for treatment, they can call the Illinois Substance Use Helpline at 1-833-2FINDHELP to identify local addiction treatment resources.  Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) behavioral health treatment finder can be used to identify locations by type of treatment: https://findtreatment.samhsa.gov/