Opioids and Pain: Comprehensive Review
Date: <<Miscellaneous:Date>>

Patient name: <<Patient Demographics:Full Name>>
DOB: <<Patient Demographics:DOB>>

Stable on current medication: <<Stable on current medication>>
Up to date with relevant blood tests: <<Up to date with relevant blood tests>>
Up to date with relevant imaging: <<Up to date with relevant imaging>>
Up to date with relevant referrals: <<Up to date with relevant referrals>>
Care plan or other comprehensive pain review up to date or booked: <<Care plan or pain review up to date or booked?>>

Nurse History and Assessment:
<<Nurse History and Assessment>>
(If any new concerns, requires a double appointment with Doctor)

Review of Non-Pharmacological Strategies:
Exercise therapy (what, how often and for how long): <<Exercise therapy (what, frequency and duration)>>
Education (e.g. pain toolkit, other websites, brochures, courses): <<Education (e.g. pain toolkit, websites, brochures...)>>
Psychology (CBT, mindfulness): <<Psychology (CBT, mindfulness)>>
Physical (physio, chiro, massage, needling, etc.):<<Physical (physio, chiro, massage, needling, etc.)>>
Spiritual (identify and seek meaningfulness and purpose of life): <<Spiritual (identify and seek meaning and purpose)>>
Social (work, family, relationships etc. and impact on pain): <<Social (work, family etc. and impact on pain)>>
Medical/surgical (injections, surgery): <<Medical/surgical (injections, surgery)>>

Pharmacological History:
Paracetamol regular or PRN: <<Paracetamol regular or PRN>>
NSAIDS regular or PRN: <<NSAIDS regular or PRN>>
Topical? <<Topical?>>
Lyrica? <<Lyrica?>>
Endep? <<Endep?>>
Duloxetine or other SSRI? <<Duloxetine or other SSRI?>>
Complementary and alternative? <<Complementary and alternative? >>
Cannabis (prescribed or not): <<Cannabis (prescribed or not)>>
Opioids - approx. year started: <<Opioids - approx. year started>>
Opioids - dose or medication changes over time: <<Opioids - dose or medication changes over time>>
Opioids - side effects reported: <<Opioids - side effects reported>>
Opioids - last attempted taper and details: <<Opioids - last attempted taper and details>>
Opioids - patient understanding of long term risks? <<Opioids - patient understanding of long term risks? >>

Side Effects
Common side effects include, but are not limited to:
 Constipation, nausea, vomiting
 Sedation, impaired psychomotor function
 Urinary retention
 Respiratory, renal or hepatic insufficiency
 Sleep apnoea
 Mental illness, including substance use disorder
 Hypogonadism - testosterone deficiency - erection problems and low libido, weight gain, low moods, low energy
 Opioid induced hyperalgesia
 Immune suppression
 Increased risk of heart attacks

Informed Consent
More and more evidence is accumulating regarding the less noticeable long term damage that can be done by opioid medications over many years. They can actually reduce life expectancy and worsen pain for some people. However, many people do have increased quality of life on a stable dose in the longer term. We need to assess the risks and benefits for each individual, and inform you of the risks so you can weigh them against your benefits. 

Patient responsibilities:
Patient responsibilities include:
 Taking opioids only as prescribed, 
 Not taking a higher dose or more often than prescribed before discussion with your Doctor, 
 Not obtaining opioids from other prescribers
 Booking appts for scripts in advance, (same day will not be accommodated more than once)
 Making a double appt for any other issues - a full standard appt is required for a script.	
 Taking care not to lose any scripts or pills - these will not be replaced.

Yearly review by a different GP or Specialist:
Who: <<Name of different GP or specialist for annual review>>
When: <<When will review by different doctor happen?>>

Signed: 
<<Doctor:Full Details>>
  
Date: <<Miscellaneous:Date (short)>>