Continuing Opioids

To determine the benefit of opioid therapy, these areas should be evaluated at regular intervals:

• Progress towards goals:

  • Pain
  • Functional status
    • General Activity Level
    • Quality of Life

The PEG scale provides a three-item assessment of pain intensity and interference (see below).

Scoring the PEG: average all three responses to get a total PEG score out of 10. This final PEG score can mean many different things, depending on the patient. Like most other screening instruments, the PEG score is most useful in tracking changes over time. PEG scores should decrease after therapy has begun.

• Review engagement in self-care:

  • Does the patient exercise regularly?
  • Does the patient employ stress reduction techniques?
  • Does the patient employ non-pharmacological modalities (e.g. cold and heat) to reduce his or her pain?
  • Is the patient pacing his or her activity to minimize pain flare ups?

• Review adjunctive treatments:

  • Is the patient engaged in behavioral counseling?
  • Is the patient attending physical therapy?
  • Would a change in nutrition or weight loss benefit the patient?
  • Other modalities:

• Acupuncture
• Yoga
• Massage

Sources:

Institute of Medicine. Relieving Pain in America. Washington DC.

Krebs EE et al. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. Gen Intern Med 2009;24(6):733-8.

Passik SD, et al. A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004;26:552-561.