The rules apply to physicians caring for adult patients experiencing “chronic non-cancer pain” and do not apply to palliative, hospice or end-of-life care, or to acute pain caused by injury or surgical procedure. The rules identify new, detailed requirements for patient evaluation, treatment plans, informed consent and written agreements for treatment. There is a mandatory consultation requirement for any patient that meets or exceeds a per day dosage amount of 120 milligrams morphine equivalent dose (MED). There are some exemptions from the consultation requirement permitted in the rules. Please make time to read the rules and become familiar with the requirements.
MQAC Rules for Management of Chronic Non-Cancer Pain
MQAC Rules for MD’s – effective January 2, 2012
MQAC Rules for DO’s – effective July 1, 2011
AAFP Member Only Resources
Chronic Pain Management Toolkit – The toolkit includes an action plan, pain inventory, work questionnaire, medication agreement between patient and physician, an opioid risk tool and links to additional AAFP and external resources for physicians. These tools can be used together or separately, depending on practice need. Everything included in the toolkit is consistent with key recommendations in the CDC and Federation of State Medical Board guidelines. The toolkit is a dynamic resource and will evolve as more resources are added in order to provide the most up-to-date information to Academy members.
Free CME Webcast on Chronic Opioid Therapy – This hour-long CME webcast on chronic opioid therapy was recorded May 27, 2016, and is valued at one AAFP Prescribed credit. David Walsworth, MD, associate chair for clinical affairs and associate professor in the family medicine department at the College of Human Medicine, Michigan State University, East Lansing, presents the course that teaches family physicians how to evaluate patients presenting with chronic nonterminal pain to assess for potential opioid responsiveness and opioid risk.
Other Pain Management Resources
The Agency Medical Directors Group (AMDG) has developed free CME including a video on the rules. The AMDG website also has information on opioid dosing guidelines and a conversion calculator as well as other resources that may prove helpful. In 2015, the AMDG updated the Interagency Guideline on Prescribing Opioids for Pain in partnership with a broad advisory group of the state’s academic leaders, pain experts, and clinicians in both primary care and specialty areas. The new guideline offers a balanced approach to pain management that includes recommendations for multimodal non-opioid therapies and opioids when appropriate. The 2015 Interagency Guideline on Prescribing Opioids for Pain now replaces the 2010 Opioid Dosing Guideline.
The article Clinical Guidelines for the use of Chronic Opioid Therapy in Chronic Noncancer Pain contains recommendations for monitoring of patients with different levels of risk.
University of Washington (UW) Pain Medicine Provider Toolkit. Includes downloadable resources and links regarding pain management: Guidelines, Tools, Access to Specialists, Rules, UW Pain Education, Selected References, UW Pain Research, and Patient Education Resources.
University of Washington (UW) TelePain. These weekly UW TelePain sessions, offer an audio and videoconference-based consultative knowledge network of interprofessional specialists with expertise in the management of challenging chronic pain problems. The goal is to increase the knowledge and skills of community practice providers who treat patients with chronic pain.
Prescription Monitoring Program (PMP)
The PMP is a secure online database that is used across Washington State to improve public health. Practitioners have access to their patient’s information before they prescribe or dispense drugs. This allows them to look for duplicate prescribing, possible misuse, drug interactions and other potential concerns. More information means better patient care.