Date of Publication
Amy O'Meara, DrNP, APRN
An estimated 20% of patients with non-cancer pain symptoms or pain-related diagnoses receive an opioid prescription. Current guidelines advocate use of a functional assessment as a strategy to improve the efficacy and safety of chronic pain management using opioids. This project aimed to integrate functional assessments into patient care visits for chronic pain and optimize safe and effective prescribing.
This quality improvement project was conducted at a primary care clinic in Burlington, VT. Baseline data on current functional assessment utilization and barriers amongst providers were collected. The validated Pain, Enjoyment, and General Activity (PEG) scale was administered from November 2018 through February 2019 during routine chronic pain visits with a nurse practitioner (NP) identified as having a large panel of patients suffering from chronic pain. Post-visit descriptive statistics were computed. A summative exit interview was completed with the NP.
Baseline data of clinic providers (n = 5) demonstrated that while 80% reported that functional assessments have value in managing chronic pain, only 20% used them regularly.
Following use of the PEG (n = 16 patient encounters) the NP demonstrated consistent documentation of PEG scores in the medical record (94%), increased conversations regarding chronic pain (56%), better use of safe and effective prescribing strategies (44%), improved understanding of patient pain/function (38%), and informed the plan of care (13%). Exit interviews demonstrated that the PEG was quick, easy to use, and helpful in initiating conversations about goals of care and opioid use and ultimately has a role in future care.
While the PEG exhibited limited impact on plan of care, it provided measurable data and may be valuable as a vehicle for broader discussions on chronic pain management and other components of evidence-based prescribing practices for non-cancer, non-palliative pain.
Stevens, Jude Emerson, "Implementation of a Chronic Pain Functional Assessment Tool in Primary Care Practice" (2019). College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications. 28.