Table 1.

Operational definitions

Functional status	Notation addressing the impact pain has on ability to function physically, socially or occupationally and also may include activities of daily living or any medical record documentation of patient walking or exercising
Depression	Notation addressing depressive symptoms by discussion of depressed mood, documenting depressive symptoms or formal assessment of depression
Anxiety	Notation addressing anxiety or fear as it is related to a pain condition by documenting anxiety symptoms or formal assessment of anxiety
Substance use/abuse	Notation indicating evaluation of current substance use and document non-substance use or indicating that patient participates in a substance abuse treatment program
Psychosocial stressors	General discussion of life stressors, problems at work, at home or in relationships
Prescribed non-opioid medications	Evidenced by prescription from provider or provider’s recommendation of patient to use non-opioid pain medications (e.g. capsaicin cream, NSAIDs)
Rotated opioid medication	Evidenced by change to a new pain medication in hopes of improved pain control or reduction in side effects
Tapered the dose of opioid medication	Evidenced by an explicit statement that the provider is titrating the dose of the patient’s pain medication or marked reduction in opioid dose with appropriate documentation
Administered urine drug screen	Documentation by clinician of results of a urine drug screen that had been performed at the time of the visit or within 30 days prior to appointment, or review of laboratory data indicating urine drug screen was administered
Discussed side effects of opioid prescriptions	Notation addressing common side effects of opioid pain medications or indication that patient and provider discussed potential side effects
Considered a non-pharmacological approach	Provider documented consideration, discussion or patient education about self-management or non-pharmacological pain management treatments
Patient participated in non-pharmacological approach	Documentation in medical record that patient engaged in a self-management or non-pharmacological pain management treatment
Collaboration with mental health provider	Notation identifying mental health care in the clinical note, designating mental health provider as a co-signer of the note or identifying a mental health goal in the note
Consulted with a pain specialist	Notation identifying recommendation, referral or current consultation with pain specialist, pain treatment program, surgeons or other provider (e.g. anaesthesiologist, physiatrist and rheumatologist), specifically for the treatment of pain
Developed a pain goal	Notation addressing work towards a goal related to chronic pain by creating specific physical, social or occupational activities, medication dosage or reduction in pain score that the patient would like to integrate into the treatment plan (i.e. ‘When asked about goals, patient wants to be able to do his mother-in-law’s yard-work without having to stop due to pain)

NSAIDs, non-steroidal anti-inflammatory drugs.