Table 3.

Chronic Pain Management Registry: Concordance with ASIPP Recommendations for Assessing the Continued Effectiveness of Opioid Therapy

ASIPP Recommendations: Assessing Opioid Continued Medical Necessity
Analgesia: Pain Level	Prior to each practice visit the patient reports on pain intensity by pain location carrying forward the initial pain intensity status and comparing that to the pre-visit status for all follow-up visits.
Activity: Functional Status	Prior to each practice visit the patient reports on functional status by pain location carrying forward the initial functional status score and comparing that to the pre-visit status score for all follow up visits.
Aberrant Medication Behavior	Prior to each follow up visit over the course of treatment, patients report on their medication aberrant behavior; this reported to the treating physician prior to the practice encounter
Adverse Effects	Dose related adverse events are recorded by the physician/practice following each encounter with the patient and coded to ICD-10-CM standards.
Overall Response to Therapy: PGIC	Prior to each visit the patient completes the PGIC scale. This asks patients to indicate, since beginning their treatment how they would describe the change (if any) in activity limitations, symptoms, emotions and overall quality of life related to their pain condition. A seven point response scale ranges from “No change (or condition got worse)' to ‘A great deal better and a considerable improvement that has made all the difference'.
ASIPP Recommendations: Physician/Practice Compliance and Physician/Practice Response
Analgesia: Pain Level and Functional Status	After each visit the physician/practice reports on medication utilization to identify opioid formulation, dosing, number of tablets/polls per day, days supplied, whether titration is occurring and if the medication is for rescue purposes. This allows the change in pain level to be matched to dosing regimen and the medical necessity of continued opioid use considered.
Titration	The CPMR asks the physician practice to report titration and allow this to be tracked for the patient over the course of treatment.
Tapering and Discontinuation of Opioid Therapy	After each visit the /physician practice is asked to report on any activities directed towards tapering or discontinuation of opioid therapy. The practice is given a number of options to report including failure to achieve significant analgesia/functioning, excessive dosing to achieve targets, presence of risk factors (e.g., sleep apnea), medication aberrant behavior and failure to meet opioid agreement standards.
Therapy options to opioids	After each visit the practice is asked to report on whether at that visit the patient was offered alternative non-opioid interventions in order to resolve issues with pain experience and/or functionality. If alternatives were offered then they are to be detailed.
Scheduling and Treatment Termination	At each visit the physician is asked to report whether or not a further visit has been scheduled for the patient.
ASIPP Recommendations: Long Acting and High Dose Opioids
Tracking formulations and dosing	At each visit the practice reports on the medications current prescribed to include opioid formulation, dosing and number of tablets/pills prescribed. The CPMR allows the physician to track dosing over the course of therapy. The platform can be customized if a practice wishes to flag low dose (e.g. <40 MME), moderate dose (41 to 90 MME) or high dose (>90 MME) patients.
Therapy modifications	The physician practice is required to report on all modifications to the initial therapy regimen, to detail and medication supplementation and the report on whether or not alternative treatment interventions were offered and accepted.