
Persistent and Breakthrough Pain
Balancing the Benefits and Risk of Opioid-Based Therapy
Meeting Slides

Linked Resources
Persistent Pain and BTP Semi-Structured Questionnaire
Brennan MJ, Bruckenthal P, Datta S, Gudin JA, Schottenstein DC. Preliminary development of a semistructured approach to persistent and breakthrough pain assessment. Paper presented at: PAINWeek; September 6-11, 2010; Las Vegas, NV.
4 A's Patient Reassessment Chart Note
Adapted from Passik SD, Kirsh KL, Whitcomb L, et al. A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004;26(4):552-561.
Patient-Prescriber Agreement Form from the TIRF REMS Access Program
For instructions on enrolling into the TIRF REMS Access program, please go to www.TIRFREMSaccess.com.
TIRF REMS Access Education Program Materials and Knowledge Assessment
The TIRF REMS Access Education Program is designed to outline the key safety information critical for minimizing the risks of abuse, misuse, overdose, addiction, and serious complications associated with medication errors associated with TIRF medicines to ensure safe use.
TIRF REMS Access Program - Prescriber Enrollment Form
For real-time processing of this enrollment form electronically, please go to www.TIRFREMSaccess.com and ‘Log In’ (if you have previously enrolled in a REMS program for one of the TIRF medicines) or ‘Create an Account’ to get started.
Opioid Risk Tool
Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005;6:432-442.
The Numerical Opioid Side Effect (NOSE) Assessment Tool
Smith HS, Kirsh KL. Documentation and potential tools in long-term opioid therapy for pain. Med Clin North Am. 2007;91(2):213-228.
Checklist for Signs of Opioid Misuse, Abuse, or Diversion
Adapted from Utah Department of Health. Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain. Salt Lake City, UT: Utah Department of Health; 2009.
Daily Pain Chart
Adapted from Rhiner M. The American Pain Foundation TARGET Chronic Pain Initiative: better patient/clinician communication to improve pain management. J Pain Palliat Care Pharmacother. 2004;18(4):55-63.
Hospice Initial Pain Assessment
Adapted from Miller KE, Miller MM, Jolley MR. Challenges in pain management at the end of life. Am Fam Physician. 2001;64(7):1227-1234.

Fundamentals of Breakthrough Pain: Assessment and Differential Diagnosis
Michael J. Brennan, MD
Balancing the Benefits and Risks of Opioid-Based Therapy
Relevant Resources
Individualized Assessment and Mechanism-Based Multimodal Treatment
Responsible Opioid Prescribing to Achieve Individualized Functional Goals
Overcoming Pain and Gastrointestinal Distress to Improve Patient Outcomes
Proactive Diagnosis and Targeted Management
Selecting Patients and Optimizing Long-Term Outcomes
Proactive Diagnosis and Targeted Management
Consensus and Controversies for Responsible Opioid Prescribing
The Role of Nurses in Optimizing Long-term Outcomes
Evolving Best-Practice Strategies to Maximize Efficacy and Safety
A Focus on Patients With Opioid-Induced Constipation
Patient Selection, Treatment Initiation, and Ongoing Monitoring
Engaging With Patients About Opioid-Induced Constipation
The PCP’s Role in Timely Recognition and Referral
Debates and Discussions About Therapeutically Targeting Nerve Growth Factor Signaling
Expanding the Conversation on Opioid-Induced Constipation
Translating Guidelines Into Patient Care
New Paths to Chronic Pain Management
Unlocking Novel Paths to Patient Care
Getting on the Fast Track to Identify AxSpA