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.