Chronic pain management resources
Guidelines
Guidelines and Coverage for treatment of Chronic Pain on the Oregon Health Plan (OHP):
- Physical Therapy and Occupational Therapy, for qualifying conditions are covered up to 30 visits/year as long as documentation of progress.
- Spine conditions, including chronic conditions, receive up to 30 visits/year of any combination of:
- Acupuncture
- Chiropractic or osteopathic manipulation
- Massage
- Pelvic physical therapy for treatment of interstitial cystitis, up to 30 visits/year.
- Trochanteric bursitis includes up to 30 visits of physical therapy/year and steroid joint injections.
- Spinal cord stimulator trial and when appropriate, implantation, are covered for chronic neurological and spinal conditions.
- Diagnostic sacroiliac joint (SIJ) injections and SIJ fusion surgery are covered.
- Yoga, massage (outside of a physical therapy clinic and limited to one session per week), Pilates, supervised exercise therapy, intensive interdisciplinary rehabilitation are covered for back and spine conditions as long as making progress.
Guideline notes
October 1, 2024 Prioritized List of Health Services (oregon.gov)
Please see “STATEMENT OF INTENT 5: TREATMENT OF CHRONIC PAIN.”
GUIDELINE NOTE 6, REHABILITATIVE AND HABILITATIVE THERAPIES
GUIDELINE NOTE 28, TROCHANTERIC BURSITIS
GUIDELINE NOTE 56, NON-INTERVENTIONAL TREATMENTS FOR CONDITIONS OF THE BACK AND SPINE
GUIDELINE NOTE 57, PELVIC PHYSICAL THERAPY FOR INTERSTITIAL CYSTITIS
GUIDELINE NOTE 92, ACUPUNCTURE
GUIDELINE NOTE 135, FIBROMYALGIA
GUIDELINE NOTE 161, SACROILIAC JOINT INJECTIONS AND SACROILIAC JOINT FUSION
GUIDELINE NOTE 170, INTRATHECAL OR EPIDURAL DRUG INFUSION
GUIDELINE NOTE 178, SPINAL CORD STIMULATOR THERAPY
Medications:
DIAGNOSTIC GUIDELINE D23, URINE DRUG TESTING
GUIDELINE NOTE 60, OPIOIDS FOR CONDITIONS OF THE BACK AND SPINE
GUIDELINE NOTE 175, MEDICATION-ASSISTED TREATMENT OF OPIOID DEPENDENCE
Many nerve blocks and injections are not covered secondary to lack of evidence of any benefit, or evidence of harm.
- See ANCILLARY GUIDELINE A1, NERVE BLOCKS
- GUIDELINE NOTE 37, SURGICAL INTERVENTIONS FOR CONDITIONS OF THE BACK AND SPINE OTHER THAN SCOLIOSIS
- GUIDELINE NOTE 104, NEWER INTERVENTIONS FOR OSTEOARTHRITIS OF THE KNEE
- Below the funding line: GUIDELINE NOTE 217, PLANTAR FASCIA INJECTION
Learn more about OHA’s coverage and guideline decisions for the treatment of back and spine pain.
Forms
Resources
Oregon Pain Guidance (OPG): Treatment Guidelines for Pain Prescriptions
Opioid-Withdrawal-Attenuation-Cocktail.pdf (oregonpainguidance.org)
Oregon Medical Board : Pain Management : Topics of Interest : State of Oregon
2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain
Pain Management & Opioid Use | AAFP
AAFP Chronic Pain Management Toolkit | AAFP
Treating Opioid Use Disorder as a Chronic Condition (aafp.org)
NALOXONE
Naloxone is a pure mu antagonist, and as such, it is an antidote to the effects of opioid intoxication. It reverses respiratory depression that is the cause of death in an opioid overdose. Naloxone has essentially no adverse effects and is remarkably successful in reversing the life-threatening effect of opioids. The incidence of opioid overdose is dose related, but anyone taking opioids is potentially at risk. Therefore, we recommend co-prescribing naloxone for the families and loved ones of all patients prescribed opioids for chronic use.
Naloxone displaces other opioids off the mu receptor sites, but it has a short half-life, having an effect for 30 to 90 minutes. After the drug wears off, the agonists may again reattach to the receptors. Anyone requiring naloxone treatment should be transported to an emergency department for further evaluation since return to the overdose state is possible with the passage of time after the initial naloxone treatment.
Naloxone can be administered parenterally (IV or IM), but it is also effective as a nasal spray. The drug has a very rapid onset of effect when given IV. Its onset of action is more gradual, but still lifesaving, when given via intra-nasal spray. Lay persons can easily be trained to use the intranasal product.
Naloxone is a drug administered by another person to rescue an individual who is overdosing on an opioid. Friends or relatives are often the ones who are present at the time of an overdose and are therefore the individuals who need to receive naloxone training.
Naloxone co-prescribing
Everyone taking opioids on a daily basis should have their friends or loved ones trained in naloxone use. It should be a part of a routine prescribing protocol for prescribers. It communicates your concerns about safety to your patient.
Many states allow lay-person use of naloxone, many insurance companies will pay for the drug, and in Oregon, a simple online training course will suffice to allow dispensing of the drug.
In 2014, 52 people died every day in the United States from prescription-opioid-related overdoses. Cities and states with naloxone distribution programs have seen 37–90% reductions in overdose deaths. Co-prescribing naloxone with medications is an important component of opioid therapy. Patients and their providers commonly underestimate the chance of experiencing an overdose. “Risky drugs, not risky people” is a useful phrase to use when explaining the necessity of naloxone co-prescribing to patients.
Overdose risk factors
As was stated earlier, all individuals taking opioids are at some risk of an overdose. Certain factors will increase that risk:
- Individuals taking sedative-hypnotics (alcohol, benzodiazepines) in addition to opioids are at increased risk. Such individuals may have a partial response to naloxone, since the drug only acts to reverse the opioid component of the overdose.
- Individuals whose opioid tolerance has decreased are at risk. This includes people who leave residential addiction-treatment programs or are released from incarceration.
- Individuals whose dose of opioids suddenly increased are at risk. For example, a sudden increase in opioid dosing or a new source of heroin that is stronger than the user expected could result in overdose.
- Someone who has previously overdosed is at risk of overdosing again.
Further resources
Naloxone for overdose prevention/treatment
Opioid Overdose
The following training protocol related to opioid overdose was developed in response to the 2013 Oregon Law, Chapter 340. This legislation codified under ORS 689.681 was subsequently amended repealing training requirements on lifesaving treatments for opiate overdose and the requirement that the Authority adopt administrative rules establishing protocols and criteria for such training. OARs 333-055-0100 through 0115 were repealed in December 2020. Opioid overdose requiring lifesaving treatment occurs in a wide variety of settings and circumstances, however mandating training is unnecessary and may reduce access to naloxone. Individuals in Oregon can receive training from pharmacists who are required to provide counseling and directions for use, and from other programs such as local public health programs, social service agencies or first responders.
This training protocol created by the Oregon Health Authority, and related materials, are provided to help educate individuals on administering naloxone. These materials are for reference only and not required to be utilized under this statute.
- Opioid Overdose Treatment: Naloxone Training Protocol
- ORS 689.681
- Naloxone Rescue for Opioid Overdose (website)
Naloxone for overdose prevention/treatment
Training Videos on YouTube
- Multnomah County Sheriff's Office naloxone training
- Injectable Naloxone training video;(Multnomah County Health Dept.)
- Nasal Naloxone training video (Multnomah County Health Dept.)
- Using Adapt Nasal Narcan to Reverse Opioid Overdose (Multnomah County Health Dept.)
- Using the Evzio Auto Injector to Reverse Opioid Overdose (Multnomah County Health Dept.)
Provider resources
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