Partners Against Pain^®
Pain Management Kit

Assessment Forms

Documentation is essential for supporting the evaluation, the reason for opioid prescribing, the overall pain management plan, any consultations received, and periodic review of the status of the patient.^1-2  The essential elements for evaluating the use of controlled substances for pain control include:

1. Evaluation of the patient
2. Treatment plan
3. Informed consent and treatment agreement
4. Periodic review
5. Consultation
6. Medical records

For definitions of several important words often used in the treatment of pain, please see References for the consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.

Patient History Printable PDF: 24 KB / 2 pages
Initial Pain Assessment Printable PDF: 41 KB / 2 pages
Initial Pain Assessment Tool Printable PDF: 140 KB / 2 pages
Checklist for Long-Term Opioid Therapy Printable PDF: 667 KB / 1 page

References:
1. Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline No 9. AHCPR Publication No. 94-0592. Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, March 1994.
2. The Use of Opioids for the Treatment of Chronic Pain. A consensus statement from American Academy of Pain Medicine and American Pain Society, 1996 http://www.ampainsoc.org/advocacy/opioids