Translational Behavioral Medicine

, Volume 2, Issue 1, pp 57–64 | Cite as

Measurement of adherence to clinical practice guidelines for opioid therapy for chronic pain

  • Amanda M MidboeEmail author
  • Eleanor T Lewis
  • Meenah C Paik
  • Rollin M Gallagher
  • Jack M Rosenberg
  • Francine Goodman
  • Robert D Kerns
  • William C Becker
  • Jodie A Trafton
Practice Tool


The safe and effective prescribing of opioid therapy for chronic pain has become a significant health care priority over the last several years. Substantial research has focused on patient-oriented interventions toward preventing problematic use, but provider and system level factors may be more amenable to quality improvement approaches. Here, we outline administrative data-based metrics that are intended to assess adherence to key practices outlined in the 2010 Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for management of opioid therapy for chronic pain. In addition to the metrics, we discuss their development process, which was done in consultation with experts on chronic opioid therapy.


Performance measurement Quality improvement Clinical practice guideline Pain management Opioid Process metrics 



The project was funded by VA Health Services Research and Development (HSR&D) Quality Enhancement Research Initiative (QUERI) Project # RRP 10–106 (Trafton, PI), entitled “Assessment of gaps in chronic opioid therapy guideline adherence,” and VA Office of Academic Affiliations Advanced Fellowship in Medical Informatics (Midboe, postdoctoral fellow, VA Palo Alto Health Care System).

Conflicts of interest

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States.


  1. 1.
    Retail drug summary, 1997–2007. U.S. Department of Justice DEA, Office of Diversion Control. Accessed 2009.
  2. 2.
    Parsells KJ, Cook SF, Kaufman DW, et al. Prevalence and characteristics of opioid use in the US adult population. Pain. 2008;138:507-513.CrossRefGoogle Scholar
  3. 3.
    Boudreau D, Von Korff M, Rutter CM, et al. Trends in long term opioid therapy for chronic non cancer pain. Pharmacoepidemiol Drug Saf. 2009;18:1166-1175.PubMedCrossRefGoogle Scholar
  4. 4.
    Kuehn BM. Opioid prescriptions soar. JAMA. 2007;297:249.PubMedCrossRefGoogle Scholar
  5. 5.
    Manchikanti L, Singh A. Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11:S63-S88.PubMedGoogle Scholar
  6. 6.
    Ballantyne JC, LaForge KS. Opioid dependence and addiction during opioid treatment of chronic pain. Pain. 2007;129(3):235.PubMedCrossRefGoogle Scholar
  7. 7.
    Denisco RA, Chandler RK, Compton WM. Addressing the intersecting problems of opioid misuse and chronic pain treatment. Exp Clin Psychopharmacol. 2008;16:417.PubMedCrossRefGoogle Scholar
  8. 8.
    Martell BA, O’Connor PG, Kerns RD, et al. Systematic review: opioid treatment for chronic back pain: Prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146:116.PubMedGoogle Scholar
  9. 9.
    Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-130.PubMedCrossRefGoogle Scholar
  10. 10.
    Turk DC, Swanson KS, Gatchel RJ. Predicting opioid misuse by chronic pain patients: A systematic review and literature synthesis. Clin J Pain. 2008;24:497.PubMedCrossRefGoogle Scholar
  11. 11.
    VA/DoD Opioid Therapy for Chronic Pain Working Group. The management of opioid therapy for chronic pain. Washington, DC: The Office of Quality and Performance, VA and Quality Management Directorate, US Army MEDCOM; 2003.Google Scholar
  12. 12.
    VA/DoD Opioid Therapy for Chronic Pain Working Group. (2010). The management of opioid therapy for chronic pain.
  13. 13.
    Wobrock T, Weinmann S, Falkai P, Gaebel W. Quality assurance in psychiatry: quality indicators and guideline implementation. Eur Arch Psychiatry Clin Neurosci. 2009;259:219-226.CrossRefGoogle Scholar
  14. 14.
    King N. Template analysis. In: Symon G, Cassell C, eds. Qualitative methods and analysis in organizational research. Thousand Oaks, CA: Sage Publications; 1998:119-134.Google Scholar
  15. 15.
    Michel MC, Trafton JA, Martins SB, et al. Improving Patient Safety using ATHENA-Decision Support System Technology: Opioid Therapy for Chronic Pain. In: Henriksen K, Battles J, Keyes M, Grady M, eds. Advances in Patient Safety: From Research to Implementation. Rockville, MD: Agency for Healthcare Research and Quality; 2008:1-12.Google Scholar
  16. 16.
    Trafton JA, Martins SB, Michel MC, et al. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain. Implement Sci. 2010;5:11.CrossRefGoogle Scholar
  17. 17.
    VA/DoD Clinical Practice Guideline for Management of Obesity and Overweight, Accesssed 2006.
  18. 18.
    VA/DoD Clinical Practice Guideline for Tobacco Dependence and Use, Accessed 2008.
  19. 19.
    Weinmann S, Koesters M, Becker T. Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatr Scand. 2007;115:420-433.PubMedCrossRefGoogle Scholar
  20. 20.
    Novak S, Nemeth WC, Lawson KA. Trends in Medical Use and Abuse of Sustained Release Opioid Analgesics: A Revisit. Pain Med. 2004;5:59-65.PubMedCrossRefGoogle Scholar
  21. 21.
    Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999–2006. NCHS Data Brief. 2009;1.Google Scholar
  22. 22.
    Dassanayake T, Michie P, Carter G. Jones A Effects of Benzodiazepines, Antidepressants and Opioids on Driving: A Systematic Review and Meta-Analysis of Epidemiological and Experimental Evidence. Drug Saf. 2011;34:125-156.PubMedCrossRefGoogle Scholar
  23. 23.
    Larson AM, Polson J, Fontana RJ, et al. Acetaminophen induced acute liver failure: Results of a United States multicenter, prospective study. Hepatology. 2005;42:1364-1372.PubMedCrossRefGoogle Scholar
  24. 24.
    Eccleston C, Williams A, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews (Online). 2009; CD007407.Google Scholar
  25. 25.
    Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Heal Psychol. 2007;26:1-9.CrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2011

Authors and Affiliations

  • Amanda M Midboe
    • 1
    • 2
    Email author
  • Eleanor T Lewis
    • 1
  • Meenah C Paik
    • 1
  • Rollin M Gallagher
    • 3
  • Jack M Rosenberg
    • 4
  • Francine Goodman
    • 5
  • Robert D Kerns
    • 6
    • 7
  • William C Becker
    • 8
    • 9
  • Jodie A Trafton
    • 1
    • 10
  1. 1.Center for Health Care EvaluationVA Palo Alto Health Care SystemMenlo ParkUSA
  2. 2.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  3. 3.Departments of Psychiatry and Anesthesiology and Critical Care, Penn Pain Medicine CenterUniversity of Pennsylvania School of Medicine, Philadelphia VA Medical CenterPhiladelphiaUSA
  4. 4.University of MichiganVA Ann Arbor Health Care SystemAnn ArborUSA
  5. 5.U.S. Department of Veterans AffairsPharmacy Benefits Management ServicesHinesUSA
  6. 6.Pain Research, Informatics, Medical Comorbidities, and Education CenterVeterans Affairs Connecticut HealthCare SystemWest HavenUSA
  7. 7.Departments of Psychiatry, Neurology, and PsychologyYale UniversityNew HavenUSA
  8. 8.Department of MedicineYale University School of MedicineNew HavenUSA
  9. 9.VA Connecticut Healthcare SystemWest HavenUSA
  10. 10.Center for Health Policy/Center for Primary Care and Outcomes Research (PCOR)Stanford UniversityStanfordUSA

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