The rules specify that “periodic review” of the treatment course for chronic pain must take place every six months. Reviews may be conducted annually for stable patients with chronic pain involving non-escalating daily dosages of 40 milligrams of a morphine equivalent dose (MED) or less.
These reviews must document:
1. The patient’s general state of health, and any new information about the etiology of the pain
2. The patient’s overall compliance with any medication treatment plan
3. An assessment of the extent to which pain, function, or quality of life have improved or diminished, using “objective evidence,” such as a validated questionnaire, or considering any available information from family members or other caregivers
4. An assessment of the appropriateness of continuing the treatment plan based upon the patient’s progress or compliance
5. Documentation of date from Prescription Monitoring Program or Emergency Department Information Exchange databases, or pharmacist information concerning concurrent prescriptions of psychoactive medications, to avoid possible dangerous drug interactions. (Remember that a Prescription Monitoring Program is not yet available in Washington State, but is currently under development.)
If progress or compliance is unsatisfactory, consider (and document your decision about) tapering, changing, or discontinuing treatment, especially when: