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Algorithm 1

Patient with chronic non-cancer pain [A] Comprehensive Assessment: History: Pain history and results of previous treatments, impact pain on family, work, and life, review of previous diagnostic studies, additional consultations and referrals, coexisting illnesses and treatments and effect on pai
History and physical to obtain comprehensive assessment [B]
Complete assessment of pain; Determine cause of pain, if possible [C]
Are there contraindications to opioid therapy that cannot be resolved? [D] Exit Algorithm Symptom attributes: Duration of symptom, onset and triggers, location, co-morbidity, previous episodes, intensity and impact, previous treatments and medications, past medical, surgical and psychological history, patient preception of symptom
Are other non-opioid medications and modalities indicated? Implement other modalities and follow up
Are there indications for referral/consultation? [E] Refer/consult with appropriate specialist
Is opioid therapy indicated at this time? [F] Educate patient and family about treatment options; Share decision about goal and expected outcome of therapy [G]
Does patient accept opioid therapy? Discuss treatment agreement with patient and family. Obtain a written opioid treatment agreement [H]
Continue follow-up and other pain therapies; Periodically reeevaluate for opioid therapy Determine and document treatment plan
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