Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 6659 MSFocus Summer 2016 • Recommendation 2: Before starting opioid medications for chronic pain, healthcare providers should establish treatment goals, including realistic goals for pain and function, and determine when or if the opioid medications will be discontinued if the risks outweigh the benefits. Opioid medications should only be continued when benefits outweigh risks. (Recommendation category, A; evidence type, 4) • Recommendation 3: Before starting opioid medications and periodically during therapy, clinicians should discuss known risks and realistic benefits of opioid therapy. (Recommendation category, A; evidence type, 3) • Recommendation 4: When initiating treatment with opioid medications, healthcare providers should prescribe immediate-release opioids instead of extended-release opioids. (Recommendation category, A; evidence type, 4) • Recommendation 5: When initiating treatment with opioid medications, healthcare providers should prescribe the lowest effective dose. (Recommendation category, A; evidence type, 3) • Recommendation 6: When opioids are used to treat acute pain, healthcare providers should prescribe the lowest possible dose of immediate-release opioids. No greater quantity than needed for the expected duration of therapy should be prescribed. Three days or less will be often be sufficient; seven or more days should rarely be needed. (Recommendation category, A; evidence type, 4) • Recommendation 7: Healthcare providers should evaluate benefits and risks of therapy within one to four weeks of starting therapy with opioids. The benefits and risks should be re-evaluated every three months. If risks outweigh the benefits, the healthcare provider should taper the opioid medication or discontinue the medication. (Recommendation category, A; evidence type, 4) • Recommendation 8: Prior to starting the opioid medication and periodically during treatment, healthcare providers should evaluate risk factors for opioid-related harms. (Recommendation category, A; evidence type, 4) • Recommendation 9: Prior to starting the opioid medication, healthcare providers should review the patient’s history of controlled substance medications use. (Recommendation category, A; evidence type, 4) • Recommendation 10: When prescribing opioid medications for chronic pain, healthcare providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually. (Recommendation category, B; evidence type, 4) • Recommendation 11: Healthcare providers should avoid prescribing opioid medications with benzodiazepine medications. (Recommendation category, A; evidence type, 3) • Recommendation 12: Healthcare providers should offer or arrange evidence-based treatment for patients with an opioid use disorder. (Recommendation category, A; evidence type, 2)