Draft — pending COA review. Rette derived these criteria from the ACOEM guidelines adopted into the MTUS. They are not COA documents and have not been signed off by a COA physician reviewer.

MTUS Treatment ChecklistbyRette

Utilization Review Checklist

Opioids for Acute and Postoperative Pain

Derived from the ACOEM Opioids Guideline, edition 12 December 2023, as adopted into the California MTUS 27 March 2024. ICD-10 G89.11, G89.18, Z98.890, R52.

Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.

Patient name: Claim #:

CriteriaCheck if documented

Contraindications and Cautions

Required

  • Whether the patient performs safety-critical work has been established; if so, at least 3.3 half-lives must pass to clear 90% of the opioid before those duties resume

    it is recommended that at least 3.3 half-lives (to clear 90% of the opioid) take place after — p. 21

Procedures — the guideline treats each separately

Short-acting opioids for postoperative pain

Moderately Recommended.

Strength of Evidence — Moderately Recommended, Evidence (B) · confidence high

Indications

Any one of the following

  • Short-acting opioids for postoperative pain

    For postoperative pain management, a brief prescription of short-acting opioids as an adjunct to more efficacious treatments. — p. 51

    Required:

    • Postoperative pain, managed with a brief prescription of short-acting opioids as an adjunct to more efficacious treatments

      For postoperative pain management, a brief prescription of short-acting opioids as an adjunct to more efficacious treatments. — p. 51

Contraindications and Cautions

All of the following

  • No illicit substance use — or objective evidence of significant trauma or at least moderate-severe injury

    Patients should not receive opioids if they use illicit substances, unless there is objective evidence of significant trauma or at least moderate-severe injuries. — p. 52

  • AND

    Caution where other sedating medications or substances are in use, and the guideline's caution list has been considered

    Due to greater than 10-fold elevated risks of adverse effects and death, considerable caution is warranted among those using other sedating medications and substances, including benzodiazepines, anti-histamines (H1-blockers), and/or illicit substances. — p. 52

  • AND

    The prescription drug monitoring database has been checked for other opioid prescriptions

    Prescription databases (usually referred to as PDMP) should be checked for other opioid prescriptions. — p. 52

Prior Treatment

All of the following

  • Non-opioid prescriptions are the primary treatment and accompany the opioid

    Non-opioid prescriptions (e.g., NSAIDs, acetaminophen) should nearly always be the primary treatment and accompany an opioid prescription — p. 51

  • AND

    More efficacious treatments including therapeutic exercise, such as progressive early ambulation, especially after moderate to extensive procedures

    More efficacious treatments also include therapeutic exercises, such as progressive early ambulation, especially for moderate to extensive procedures — p. 51

  • AND

    Screening completed before initiating opioids for postoperative pain

    Screening is recommended for surgical patients prior to the initiation of opioids for postoperative pain (up to 4 weeks). — p. 57

  • AND

    Planning for postoperative opioid use began at the preoperative assessment, with a minimal effective dose strategy

    Planning for opioid use to treat postoperative pain should begin during the preoperative assessment, emphasizing a minimal effective dose strategy. — p. 52

Dose, Duration and Discontinuation

Any one of the following

  • For postoperative pain the guideline makes no recommendation on a maximum daily dose

    There is no quality evidence for dose limits for postoperative patients using opioids, and thus there is no recommendation. — p. 59

  • OR

    A brief prescription — only a short course of a few days, and opioids generally not needed at all for minor procedures

    Opioids are generally not needed for minor surgical procedures; for the exceptions, only a short course of a few days is indicated. — p. 51

Supported as a BRIEF prescription of short-acting opioids, and explicitly as an ADJUNCT — the guideline says non-opioid prescriptions should nearly always be the primary treatment and accompany the opioid. It names therapeutic exercise, including progressive early ambulation, as a more efficacious treatment, particularly after arthroplasty and fusion. Opioids are generally not needed for minor procedures at all.

Opioids for acute, severe pain

Recommended.

Strength of Evidence — Recommended, Evidence (C) · confidence high

Indications

Any one of the following

  • Opioids for acute, severe pain

    Severe injury with a clear rationale for use (objective functional limitations due to pain resulting from the medical problem, e.g., extensive trauma such as forearm crush injury, large burns, severe radiculopathy). — p. 29

    Required:

    • Acute severe injury with a clear rationale — objective functional limitations due to pain

      Severe injury with a clear rationale for use (objective functional limitations due to pain resulting from the medical problem, e.g., extensive trauma such as forearm crush injury, large burns, severe radiculopathy). — p. 29

Dose, Duration and Discontinuation

Any one of the following

  • For opioid-naïve patients with acute pain, a maximum daily oral dose of 50 mg MMEat least 50

    For opioid-naïve patients with acute pain, the recommended maximum daily oral dose based on the risk of overdose/death is 50 mg MME — p. 36

Supported where there is a severe injury with a clear rationale — objective functional limitations from pain, the guideline's examples being extensive trauma such as a forearm crush injury, large burns or severe radiculopathy. Back and neck pain NOT due to major trauma is excluded by name.

Routine opioids for nonsevere acute pain

Strongly Not Recommended. Routine opioid use is strongly not recommended for the treatment of nonsevere acute pain (e.g., low back pain, sprains, or minor/moderate injuries without signs of major tissue damage).

Strength of Evidence — Strongly Not Recommended, Evidence (A) · confidence high · p. 25

Indications — required:

  • Nonsevere acute pain — low back pain, sprains, or minor to moderate injuries without signs of major tissue damage

    Routine opioid use is strongly not recommended for the treatment of nonsevere acute pain (e.g., low back pain, sprains, or minor/moderate injuries without signs of major tissue damage). — p. 25

STRONGLY not recommended at High confidence — the firmest position in the guideline. Its own examples of nonsevere acute pain are low back pain, sprains, and minor or moderate injuries without signs of major tissue damage.

Reviewing this for COA, or think a criterion is wrong?