Resources

Prescriber Toolkit

Prescribers, pharmacists, and other health care professionals often interact with patients who are experiencing pain. This toolkit is designed to assist you in having productive conversations with patients about the Texas PMP and the safe and effective alleviation of pain.

Guidelines & Talking Points

The Basics

Physicians, nurses, pharmacists, nurse practitioners, social workers, physical therapists and other healthcare professionals often interact with patients who are experiencing pain. The guidelines and talking points below are designed to help you make these conversations effective and satisfying for everyone.

Invite participation

Invite participation by explicitly encouraging patients to respond. Asking questions like, “How does that sound to you?” before or after providing information to patients can help establish a trusting relationship. In addition, this helps providers collect information from patients.

Use motivational interviewing techniques

Use motivational interviewing techniques to encourage patients to share their stories, allowing them to explore their own circumstances and options with professional or clinical guidance. Asking open-ended questions can help identify psychosocial factors that are contributing to patient experiences of pain. Treating co-occurring psychological disorders can decrease a patient’s pain.

Use positive language

Use positive language like, “Sometimes we struggle to know exactly what causes this problem, but I can tell you that I will make my best effort to help you get comfortable” instead of, “I don’t know what’s wrong.” Avoid using negatives (e.g., “no” “not” “nothing” “never”).

Distill the information

Distill the information that patients have shared, and then keep listening. Distilling complex reflections during the interaction and leaving space for patients to interject facilitates accurate shared understanding.

Affirm resilience

Affirm resilience by offering encouraging responses when patients disclose positive coping strategies. It’s important to identify, name, and celebrate positive coping strategies so that people can maintain hope and realize they can cope with pain and other stressors.

If possible

If possible, offer immediate naloxone and overdose prevention counseling when you have concerns about a patient’s substance use. Having a behavioral health specialist on staff can help.

Still not sure if conversations about pain are going well?

Focus on making sure that the patient is the one doing most of the talking.
Practice listening while successfully resisting the urge to “fix it.”

Guidelines

"What should I do or say?"

Set the stage for a conversation about pain and opioids. Provide a safe, comfortable and private space. If possible, sit alongside the patient to foster a trusting dynamic.

"[Patient name], let’s talk more about how to get you comfortable. I’d like to know more about how you’ve managed pain in the past."

Start with open-ended questions. Ask about patients’ experiences with pain, and how they have managed pain in the past. Maintain eye contact and use visual cues to help you gather patient information.

“What can we help you with today?" “Has there been a time in your life when you have had pain? How did you manage it?”

Confirm the accuracy of the Texas PMP results. Consider printing out the PMP results or swiveling your computer screen in order to review the results alongside the patient.

“I see that [summarize the Texas PMP results].” “Have you seen any other doctors who are treating you for your pain?”

If patients have questions about the Texas PMP, explain what it is, and why you are using it.

“We use the Texas PMP for every patient. It is part of [your medical history/our protocol/our policy].”

Offer encouragement for positive or desirable pain management strategies. Ask questions to suggest alternative strategies if necessary.

"Those are great strategies for managing pain.” “Let’s talk about other ways to get you comfortable. Have you tried [massage]?” “What worked or didn’t work before?”

Consider screening patients for depression and their risk of opioid misuse or abuse. Most pain has both physiological and psychosocial elements.

"Let’s also consider the results of the [appropriate questionnaire or survey].”

If patients become upset or angry, ask about their concerns, worries or fears. Follow up with the patient’s response. Emphasize common goals like patient comfort. Acknowledge emotions, and ask open-ended questions.

“What are your concerns, worries, or fears [about using acetaminophen]? Tell me more about that.”

Avoid stigmatizing language (e.g., “addict”).

Use patient-centered language that focuses on behaviors (“misusing medication”) instead of identities (“a user”). Avoid labels.

Use affirmative language that fosters mutual trust. Avoid asking “Why don’t you...”

“We want to make sure it’s safe for you.” “What about if we…”

Demonstrate empathetic, active listening by using reflective statements and a nonjudgmental approach. Avoid seeming rushed, and pause when necessary.

“What I hear you saying is [paraphrase]. Is that right?” “I understand your concerns.” “Does that fit with what you were thinking?”

Before ending the conversation, use the teach-back method to ensure patient understanding. Ask patients to repeat back your mutually agreed upon plan using their own words. Clarify or add information when necessary.

“Can you repeat back to me what our plan is?" "Yes, and I want to remind you...”

Ask patients what questions they have. Make sure they know how to get in touch if they have questions later on.

“What questions do you have?" "We will call you tomorrow morning. Here is how you can reach us..."

Policy Template

Create a customized policy

Having a policy to refer to when talking with patients can help depersonalize discussions about safe and effective alleviation of pain.

At [ Name of clinic or hospital ] we value your safety and comfort. Before prescribing certain medications, we always check the Texas Prescription Monitoring Program (PMP), a statewide database that tracks prescription data of controlled substances and medications with misuse potential. These medications include opioids, benzodiazepines, barbiturates, stimulants, sedatives, and muscle relaxers.

Prescription TypeCommon Drug Example
Benzodiazepines Alprazolam (e.g., Xanax), clonazepam (e.g., Klonopin), diazepam (e.g., Valium)
Barbiturates Amobarbital (e.g., Amytal), secobarbital (e.g., Seconal)
Stimulants Amphetamine (e.g., Adderall), methylphenidate (e.g., Ritalin), phentermine
Sedatives Zolpidem (e.g., Ambien), Zaleplon (e.g., Sonata), Eszopiclone (e.g., Lunesta)
Muscle Relaxers Carisoprodal (e.g., Soma)

Your safety, comfort, and wellbeing are our priority. Your safety comes before all else.
[ Name of clinic or hospital ]
[ Address ]
[ Phone Number ]

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