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Pain Care Resource Manual

Berkshire Health Systems operates the New England Pain Practice at the Hillcrest Campus of Berkshire Medical Center and also maintains practices in the specialties of behavioral health, substance abuse treatment (at the McGee Unit and in collaboration with the Brien Center for Mental Health & Substance Abuse Services), rehabilitative medicine, emergency medicine, rheumatology, neurology and neurosurgery. Collectively, providers in these specialties along with other community providers have collected or created the information for this Pain Care Resource Manual. The Pain Care Resource Manual is designed to serve as a clinical toolbox for Berkshire County practitioners, providing best practices guidelines for the assessment and treatment of the chronic pain patient, suggested forms and other resources to assist in the management of those patients, and informational aids useful in responding to situations of suspected misuse or diversion of pain medication. The Pain Care Resource Manual is intended to be an evolving document, updated as needed, and the Community Pain Management Project welcomes comment and suggested improvements to the Pain Care Resource Manual from any of its users.

The Pain Care Resource Manual is divided into eight discrete sections and includes information, advice and tools concerning:

  • universal precautions useful in the assessment and treatment of all patients with complaints of chronic pain
  • a series of algorithms for evaluation and treatment planning for patients complaining of the most common types of chronic pain—back pain, complex regional pain, diffuse musculoskeletal pain, headache pain, neck pain and neuropathic pain
  • essential information about opioid analgesics, non-opioid analgesics, antidepressants and anti-epileptic drugs for use in chronic pain syndrome, medication side effects and prescribing guidelines for benzodiazepines in the treatment of alcohol and sedative-hypnotic withdrawal syndromes, neuroleptic-induced akathisia, anxiety spectrum disorders, insomnia and acute agitation and psychosis
  • Informational tools including:
    • a suggested patient-provider contract setting out the benefits and risks of controlled substances therapy, the dangers of combining pain medication with mind-altering drugs and substances (including alcohol), the need for close management of the controlled substances therapy (including the potential for random urine screens and pill counts), prohibition on after-hours or early refills and the possibility of provider termination of the therapy in the event that the provider determines that contract has been breached to patient’s potential detriment (available in English, Spanish, Portuguese and Russian)
    • recommendations for urine screening and interpretation of test results to verify that patient is not placing himself or herself in danger with therapy
    • information to assist in identifying potential abusers and diverters of pain medication
    • suggested strategies for managing patients who require discontinuation of controlled substances therapy and who require detoxification admissions
    • description of and advice for using electronic medical record alert system to assure safe treatment practices when patients seek pain medication from multiple providers
  • suggested screening forms including:
    • pain and mental health conditions screening tool
    • primary care screening tool for depression, anxiety and substance abuse risk in patients with complaints of pain
    • pain inventory (long form and short form)
    • pain assessment and documentation tool
    • pain score tracking tool
  • a description of the Multidisciplinary Pain Assessment and Treatment Program
  • legal and regulatory information including:
    • FAQ concerning legal issues involving pain practice
    • Massachusetts regulations concerning (a) use of controlled substances in treating pain, (b) nurse practitioner prescribing of controlled substances and (c) physician assistant prescribing of controlled substances
  • Contact information for various Berkshire Health Systems and community resources

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