Managing Pain in Patients With Chronic Medical Illnesses and Serious Mental Illnesses

Objectives: This study investigated the use of opioid treatment plans that included the implementation of opioid dependence risk with a validated screening tool and opioid dependence risk tool (UDT) in a noncancer palliative pain clinic. Methods: We retrospectively reviewed the medical records for diagnostic information, information on analgesic medications, daily morphine equivalent dose, presence of pain management agreements and opioid dependence risk tools (ORT), and UDT. We recorded hospital days and emergency department visits. Results: Seventy-four patients were followed for a mean of 15.9 months. Ninety-three percent of patients had pain management agreements and 74% had ORT. The median score was 8: consistent with a high risk. More than half had UDT and 17.6% of patients had unexpected findings. Fifty-nine percent of patients had a psychiatric diagnosis. Hospital days and emergency department visits decreased by more than 30% (P =.015 and P =.019). Significance of Findings: Both mental health problems and aberrant drug use were common in patients seen in a noncancer palliative care clinic. There were significant reductions in acute care utilization in the 12 months post intake in the clinic.