II. Indications
- Assessment of a patient on selection for Chronic Opioid management
III. Criteria: Diagnosis
- Score 1: Benign chronic condition, minimal objective signs (e.g. Fibromyalgia, Migraines, low back)
- Score 2: Slowly progressive condition with moderate pain (e.g. failed back surgery, Neuropathy)
- Score 3: Advanced condition associated with severe pain (e.g. severe spinal stenosis)
IV. Criteria: Intractability
- Score 1: Few therapies tried and patient is passively involved in management
- Score 2: Most therapies tried but patient not completely engaged in management, or barrier limited
- Score 3: Inadequate response to full spectrum of therapy despite maximally engaged patient
V. Criteria: Risk - Psychological
- Score 1: Serious mental illness or Personality Disorder
- Score 2: Moderate interference from mental health condition (e.g. depression, Anxiety Disorder)
- Score 3: No significant underlying mental illness and communicates well in clinic
VI. Criteria: Risk - Chemical Health
- Score 1: Active or recent use of Illicit Drugs, excessive Alcohol or prescription drug use
- Score 2: Uses medications to cope with stress or prior Chemical Dependency now in remission
- Score 3: No Chemical Dependency or maladaptive medication use
VII. Criteria: Risk - Reliability
- Score 1: Numerous problems with prior medications (misuse, missed appointments, non-compliant)
- Score 2: Generally reliable, but occasional lapses in compliance
- Score 3: Highly reliable patient
VIII. Criteria: Risk - Social Support
- Score 1: Chaotic life with minimal family support, close relationships or life roles
- Score 2: Relationships and life roles with some reduction
- Score 3: No social isolation with maintained family, friends and work/school involvement
IX. Criteria: Efficacy
- Score 1: Minimal pain relief or poor function despite moderate to high doses
- Score 2: Moderate benefit with improved function or insufficient trial
- Score 3: Good improvement in pain, function, quality of life with stable doses over time
X. Scoring
- Add the 7 scores above (D + I + 4R + E) = 7 to 21
XI. Interpretation
- Score 7-13: Not suitable candidate for longterm Opioid Analgesic therapy
- Score 14-21: Good candidate for longterm Opioid Analgesic therapy
XII. References
- Belgrade (2009) Chronic Pain Managament UMN CME, Minneapolis