Opioid Therapy Monitoring Tool (5As)

#Opioid Therapy Monitoring Tool (5As) CURRENT PAIN MANAGEMENT Total duration of opioid therapy: Last analgesic review: 1. Pain diagnosis(es) / location(s) / duration(s): 2. Medication (agents and daily doses): Opioid(s): Other(s): 3. Non-pharmaceutical treatments (such as heat, massage, relaxation, physical therapy, TENS): 5As QUESTIONS 1. Activity -> What progress has been made in the patient’s functional goalssince starting opioid therapy? E.g. sitting tolerance; standing tolerance; walking ability; ability to perform activities of daily living. ? 2. Analgesia -> How does the patient rate the following over the last 24 hours? On a scale from 0 to 10 where 0 = no pain, 10 = pain as bad as you can imagine. - Average pain: - Worst pain: How much relief have pain medications provided (%): ? 3. Adverse effects -> Has the patient experienced any adverse effects from medication (such as constipation, nausea, dizziness, drowsiness? ? 4. Aberrant behaviour -> (Yes/No) Has the patient been taking medication/s as prescribed? Has the patient exhibited any signs of problematic behaviours or medication abuse/misuse? - Signs of drug and alcohol use: - Unsanctioned dose escalations: - Reported lost prescriptions or requested early repeats?: 5. AFFECT: (Yes/No) Have there been any changes to the way the patient has been feeling? - Is pain impacting on the patient’s mood? - Is the patient depressed or anxious? ASSESSMENT (Yes/No) 1. Is there adequate documentation of the patient’s pain condition, general medical condition, psychosocial history, psychiatric status and substance use history? 2. Is the indication/diagnosis for prescribing opioids clearly supported and documented? 3. Is opioid medication clinically appropriate in this/these condition(s)? 4. Has opioid therapy produced and maintained a measurable improvement in the patient’s functional capacity? 5. Are non-drug therapies maximised? 6. Given the clinical complexity and risk, is the current level of medical care and multidisciplinary intervention adequate and appropriate? The following scenarios are considered complex and high risk, and may indicate the need for specialist and multidisciplinary review: Are any present (+) Yes (-) No (-) Use of two or more psychoactive drugs in combination (eg opioid, benzodiazepines, antipsychotic, anti-epileptics, and depressants) (-) Serious mental illness comorbidity taking antipsychotic medication (-) Mixed use of opioids and illicit drugs (-) Recent discharge from a correctional services facility (-) Discharge from other medical practice/s due to problematic behaviour (-) Signs of potential high-risk behaviours PLAN (+) Yes (-) No (-) Continue current opioid therapy. (-) Reduce opioid dose. (-) Change opioid. (-) Reduce and cease opioid. (-) Add non-opioid therapies. (-) Specialist review. Other comments/details:

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References

1. Executive Committee of the Federation of State Medical Boards of the United States, Inc Model policy on the use of opioid analgesics in the treatment of chronic pain. July 2013. www.fsmb.org/pdf/pain_policy_july2013

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