BlueCross BlueShield of Tennessee Administrative Services

Use of Opioids in Control of Acute Pain

DESCRIPTION

Pain is an inevitable part of life, serving either as a warning or notice of actual or perceived injury.  It is the most common reason an individual seeks medical care.  According to the United States government’s annual report of Americans’ health, 25% of adults suffered a daylong bout of pain in the past 30 days and 10% of Americans suffer from pain every day. The most common location of pain is back pain, followed by headaches and arthralgias.

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” This definition makes it clear that pain is more than a physical reaction to a stimulus and that there are multiple kinds of pain which require classification to assist in determining treatment pathways.

The most common categories of pain classification are acute and chronic.  Acute pain usually results from injury or inflammation.  It is the normal predicted physiologic response with survival value.  It may play a role in the healing process by promoting behavior that minimizes reinjury and is usually of short duration.  While 2 to 3 months is a generally accepted time frame for an acute pain condition, there is no clear understanding when or how it can transition into chronic pain, a condition which serves no useful purpose in a healing process.  Chronic pain typically develops from acute pain between 3 to 6 months and is considered pathologic.

In the treatment of pain, understanding the equianalgesic effect of various opioids and their differing doses by converting them into morphine equivalent dosing (MED or MEqD) assists in decision making for adequate but not excessive pain control.  Information on this conversion can be found from many sources.  One user-friendly source can be found at the Center for Disease Control:  http://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf.

This policy addresses the use of opioids for the treatment of acute pain. 

This policy is not intended to address the use of opioids in the treatment of active cancer pain or hospice care.

POLICY

APPLICABLE TENNESSEE STATE MANDATE REQUIREMENTS

BlueCross BlueShield of Tennessee’s Medical Policy complies with Tennessee Code Annotated Section 56-7-2352 regarding coverage of off-label indications of Food and Drug Administration (FDA) approved drugs when the off-label use is recognized in one of the statutorily recognized standard reference compendia or in the published peer-reviewed medical literature.

SOURCES

American Pain Society. (2009, February). Opioid treatment guidelines. The Journal of Pain. Retrieved February 4, 2016 from http://www.jpain.org/article/S1526-5900(08)00830-4/pdf.

Centers for Disease Control and Prevention. (2016) Proposed 2016 guideline for prescribing opioids for chronic pain. Retrieved February 4, 2016 from http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0001.

Centers for Disease Control and Prevention. (2016). National Center for Injury Prevention and Control. Common elements in guidelines for prescribing opioids for chronic pain. Retrieved February 4, 2016 from http://www.cdc.gov/drugoverdose/pdf/common_elements_in_guidelines_for_prescribing_opioids-20160125-a.pdf.

State of Tennessee: Rules of the Tennessee Department of Health. (2012). Division of Pain Management Clinics. Chapter 1200-34-01-.09 Training Requirements. Retrieved February 17, 2016 from http://share.tn.gov/sos/rules/1200/1200-34/1200-34-01.20120326.pdf.

Washington State Department of Labor and Industries. (2013, July). Guideline for prescribing opioids to treat pain in injured workers. Retrieved January 28, 2016 from National Guideline Clearing Clearinghouse.

ORIGINAL EFFECTIVE DATE:  7/1/2016

MOST RECENT REVIEW DATE:  7/1/2016

ID_Pharmacy

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.