For Providers
Resources for prescribing opioids in cancer pain
For providers
Project ECHO
The Opioids & Cancer ECHO series is designed to help healthcare professionals navigate the complexities of cancer-related pain and opioid use. Through a case-based collaborative learning model, participants can share real-world challenges, gain practical insights, and build best practices across systems. Continuing education credit is available through VCU Health.
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Clinical Guidelines
AMERICAN SOCIETY FOR CLINICAL ONCOLOGY
Use of Opioids for Adults with Pain From Cancer or Cancer Treatment
Clinical guidelines for prescribing opioids in cancer patient populations.
CENTERS FOR DISEASE CONTROL AND PREVENTION
Clinical Practice Guidelines for Prescribing Opioids for Pain (2022)
Prescribing guidelines for the use of opioids for non-cancer pain management.
virginia department of health
REVIVE! Naloxone Education
Training for patients, caregivers, and first responders on how to use naloxone to reverse accidental opioid overdose.
national comprehensive cancer network
Guidelines for Cancer Pain
Recommendations for managing cancer-related pain in adult patients.
Essential Tools
MME/MEDD Calculator
This calculator helps convert opioid doses to Morphine Milligram Equivalents (MME) or Morphine Equivalent Daily Dose (MEDD).
VA Prescription Drug Monitoring Program
Virginia state-run PMDP/PMP database that tracks prescriptions to monitor for potential misuse or overprescribing.
Pain and Symptom Assessment
Validated tools to evaluate pain and other symptoms impacting quality of life in patients with cancer.
References →
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The Brief Pain Inventory is a patient-reported questionnaire to assess cancer pain. Although the BPI short form is more commonly used in clinical practice and research, a long-form BPI is also available and includes additional clinically useful questions about pain characteristics.
The BPI asks about a patient’s worst, least, and average pain over the last 24 hours as well as pain interference with activity, mood, mobility, relationships, sleep, and quality of life.
Learn more, access the BPI user guide, or order forms from MD Anderson Cancer Center.
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The Edmonton Symptom Assessment System (ESAS) has long been used to evaluate patient-reported outcomes in palliative care. The updated ESAS-r Cancer has been revised for patients with cancer in an ambulatory setting.
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The ONC-5 is a chaplain-completed assessment of the intensity of spiritual distress in patients with cancer. Chaplains may use this model to aid in structuring conversations about patients’ spiritual and existential concerns as part of a protocol of assessment and intervention.
The original Spiritual Distress Assessment Tool (SDAT) is a conceptual model of spiritual distress assessment in hospitalized older adults.
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The PHQ-9 is the depression module of the larger Patient Health Questionnaire diagnostic instrument for common mental health concerns. This patient-reported instrument also explores how emotional difficulties impact work, home life, and relationships with others. Scores can be used to plan and evaluate treatment but should not be used to diagnose or exclude depression.
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The Patient-Reporting Outcomes Measurement Information System (PROMIS) is an extensive set of instruments to measure health outcomes and indicators from the patient perspective, including long- and short-form questionnaires and computer adaptive tests that may be built into electronic medical record systems.
PROMIS Pain Interference instruments assess the consequences of pain on relevant aspects of the patient’s life, including to what extent pain may interfere with daily life, work, cognition, physical and recreational activity, and social and emotional engagement.
A cancer-specific instrument is available to measures these consequences in the context of cancer and treatment experiences. Short-form pain interference instruments are also available. Additional information is available from HealthMeasures.net.
Opioid Risk Assessment
Validated tools to assess the risk of opioid-related harms and substance use disorders in patients prescribed opioids for pain management.
References →
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The National Institute on Drug Abuse has created a comprehensive guide to screening and assessment tools in adult and pediatric patients as well as additional specific guidance for screening for substance use in the pain management setting. These validated tools can be used to assess the risk of opioid and other substance use disorders in patients.
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The Cut down, Annoyed, Guilty, and Eye opener- Adapted to Include Drugs (CAGE-AID) questionnaire is a screening tool to assess nonmedical opioid use in patients on opioid therapy for cancer pain.
Higher scores indicate greater likelihood of alcohol/substance use problems. Positive screening should prompt further assessment and intervention as clinically appropriate.
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The Current Opioid Misuse Measure (COMM) is a self-reported 17-item questionnaire designed to aid in identifying and monitoring aberrant behaviors in patients currently on opioid therapy for chronic non-cancer pain. This tool may help in documenting continued compliance or changes in patient behavior during long-term opioid therapy.
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The Drug Abuse Screening Test (DAST-10) is a patient questionnaire useful for screening and evaluating outcomes. More information and access is available through NIDA.
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The Opioid Compliance Checklist is a patient-reported instrument reflecting the content of a typical opioid therapy agreement outlining patient responsibilities and clinic policies for prescribing opioids for chronic pain. This tool can be useful in monitoring patient-reported compliance with these policies and procedures.
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The Opioid Risk Tool revised for Opioid Use Disorder (ORT-OUD) is designed to be used in patients upon an initial visit prior to beginning or continuing opioid therapy for pain management. More information on scoring and risk is available from NIDA.
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The Pain Medication Questionnaire (PMQ) is a self-reported patient questionnaire for assessing potential opioid misuse in patients with chronic pain. Questions aim to uncover more about the patient’s thoughts, needs, and experiences relating to pain management and medication.
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The Severity of Dependence Scale (SDS) is a short questionnaire designed to assess patients for medication misuse and dependence.
This five-item assessment focuses on psychological components of dependence, including compulsive use and patient concerns about their medication use. Scoring thresholds vary by substance of concern.
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The Screener and Opioid Assessment for Patients with Pain - Revised version (SOAPP-R) is a questionnaire designed to help evaluate the risk of patients developing problems on long-term opioid therapy for chronic pain. This 24-item assessment tool is designed to be used by clinicians in assessing patient risk for aberrant medication-related behaviors.
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The Tobacco, Alcohol, Prescription medication, and other Substance use Tool (TAPS) is a combined two-stage screening and assessment tool. This brief tools combines screening for several commonly used substances to facilitate clinical assessment.
The online tool may be used by clinicians or patients, though the screening is meant to be used under provider supervision.
Palliative Care Resources
What is palliative care?
Palliative care is a specialized approach to serious illness care designed for patients with complex symptom management needs. Working collaboratively with other specialties, expert palliative care teams assess and address a patient's physical, psychological, emotional, and spiritual well-being.
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Essential tools for clinicians caring for people with serious illness.
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Advancing equitable hospice and palliative care in every setting.
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Certification, education, and research for hospice and palliative care.
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Free, evidence-based palliative care guidance at a glance.
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Comprehensive training in palliative and end-of-life care.
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News and policy updates for palliative care teams.
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Links to directories, quality measures, and patient resources.
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Guides on advance directives and end-of-life care.