March 1, 2021, 4:04 pm Michael Devitt — A new free resource is available for AAFP members who care for patients with chronic pain. The AAFP Chronic Pain Toolkit, developed by the Academy with partial funding from a Substance Abuse and Mental Health Services Administration grant and published online in February, provides family physicians with an assortment of items to aid in the effective assessment, diagnosis and management of chronic pain.
“Addressing pain is complicated. There are a lot of gray areas in treating pain, and a one-size-fits-all approach does not work,” said Lynn Fisher, M.D., an assistant professor in the Department of Family and Community Medicine at the University of Kansas School of Medicine in Wichita, and director of the rural preceptorship. “This toolkit provides us with a variety of tools that we can use to help us manage chronic pain patients and to help us follow the best available evidence at this time.”
Although the exact number of people who experience chronic pain is unknown, a 2018 study published in the CDC’s Morbidity and Mortality Weekly Report estimated that in 2016, just over 20% of all U.S. adults had chronic pain. Effective chronic pain management may be challenging, and evidence-based tools and resources such as the toolkit may help FPs and other primary care clinicians approach pain management in a multidimensional, patient-centered and goal-oriented manner.
The Chronic Pain Toolkit is divided into five sections.
Pain Assessment gives an overview of appropriate strategies and diagnostic tools used to support chronic pain assessment in patients.
Functional and Other Assessments discusses supporting tools and methods for the diagnostic assessment of functional activity and other coexisting conditions, including the patient’s emotional and mental health, quality of life, and other psychosocial factors.
Pain Management provides details on strategies and considerations for effective management of acute and chronic pain.
Opioid Prescribing covers the prescribing of opioids as it relates to the treatment of chronic pain and includes information and resources on safe prescribing practices, risk mitigation and monitoring, opioid conversion and tapering tools, and specific resources for patients.
Opioid Use Disorders: Prevention, Detection and Recovery offers a brief overview along with resources in support of opioid use disorder prevention, recognition and assessment, and treatment and recovery.
Each section contains a variety of ready-to-use tools and materials for family physicians. The Functional and Other Assessments section, for example, provides copies of several assessments that clinicians can use when determining the impact of chronic pain on their patients, including the Patient-Reported Outcomes Measurement Information System Global Health Questionnaire, the RAND Short Form Health Survey, the Work Productivity and Activity Impairment Questionnaire and a functional goals worksheet, along with a table on common coexisting conditions and a table on condition-specific functional assessment tools.
Each section of the toolkit also contains a series of references, as well as links to various reports, scientific articles and guidelines.
Fisher, who serves on the Academy’s Commission for Health of the Public and Science, was part of a panel of physicians and psychologists convened by the AAFP who participated in a work group that examined the previous version of the toolkit and provided feedback on ways to improve it and make it more useful for implementing in the office. He told AAFP News that the latest version of the toolkit should prove extremely valuable to members.
“Chronic pain continues to be an issue for many patients that AAFP members provide care for,” said Fisher. “This is a toolkit that incorporates so many resources into one document. Looking to find the latest guidelines for low back pain or acute musculoskeletal pain? Searching for evidence tables regarding pharmacologic or nonpharmacologic treatments? They are all here.”
Fisher noted that the vast number of resources and guidelines in the toolkit could modify the way some FPs currently diagnose and manage chronic pain, and he related some of his own experiences on the topic.
“In the midst of a busy practice, I often found myself lacking a systematic approach to chronic pain,” Fisher explained. “I know that I should also be screening for depression or anxiety or that I should be looking at function. I should do routine urine drug screens or check my state’s controlled-substance pharmacy website. However, I know that there are parts of the comprehensive approach to chronic pain that I do not always cover with each patient.
"This represents an opportunity to review the toolkit and think about how I can best treat my patients for chronic pain. There are many useful forms that can be used during that initial visit and subsequent office visits for chronic pain.”
Fisher also pointed to specific items in the toolkit that could be convenient for members.
“Parts of the toolkit that I think FPs will find most useful in practice include the urine drug screen resources, the guidelines for management of acute musculoskeletal and acute low back pain, and the evidence tables for pharmacological and nonpharmacological treatments of chronic pain,” Fisher said. “Often these have helped me to talk to patients about what the evidence shows has been the most helpful to address pain.”
The Chronic Pain Toolkit is the latest of several Academy resources available on this and related topics.
In February, the AAFP published an opioid use disorder treatment manual to give FPs additional guidance in treating the condition. American Family Physician, the Academy’s peer-reviewed clinical journal, has a robust collection of articles on chronic pain, and additional pain management resources are available at AAFP.org and the Academy’s patient-centered website, Familydoctor.org.
The Academy will also host a livestream course on opioid use disorder in May that can be accessed on any device. An application for CME credit has been filed. Members who register by May 14 can receive a discount.