Monitoring outcomes during long-term opioid therapy for noncancer pain: Results with the Pain Assessment and Documentation Tool


  • Steven D. Passik, PhD
  • Kenneth L. Kirsh, PhD
  • Laurie Whitcomb, MA
  • Jeffrey R. Schein, PhD, MPH
  • Mitchell A. Kaplan, PhD
  • Sheri L. Dodd, MSc
  • Leah Kleinman, PhD
  • Nathaniel P. Katz, MD
  • Russell K. Portenoy, MD



opioids, noncancer pain, assessment, documentation, outcomes


The increasingly common practice of long-term opioid therapy for chronic noncancer pain must be guided by ongoing assessment of four types of outcomes: pain relief, function, side effects, and drug-related behaviors. Our objective was to gather initial pilot data on the clinical application of a specialized chart note, the Pain Assessment and Documentation Tool (PADT), which was developed and tested with 27 physicians. This pilot test provided the means to collect cross-sectional outcome data on a large sample of opioid-treated chronic pain patients. Each of the physician volunteers (located in a variety of settings across the United States) completed the PADT for a convenience sample of personally treated chronic pain patients who had received at least three months of opioid therapy. Completion of the PADT required a clinical interview, review of the medical chart, and direct clinical observation. Data from the PADTs were collated and analyzed. The results suggested that the majority of patients with chronic pain achieve relatively positive outcomes in the eyes of their prescribing physicians in all four relevant domains with opioid therapy. Analgesia was modest but meaningful, functionality was generally stabilized or improved, and side effects were tolerable. Potentially aberrant behaviors were common but viewed as an indicator of a problem (i.e., addiction or diversion) in only approximately 10 percent of cases. Using the PADT, physician ratings can be developed in four domains. In this sample, outcomes suggested that opioid therapy provided meaningful analgesia.

Author Biographies

Steven D. Passik, PhD

Associate Attending Psychologist and Associate Professor of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, New York.

Kenneth L. Kirsh, PhD

Pharmacy Practice and Science, University of Kentucky, Lexington, Kentucky.

Laurie Whitcomb, MA

Private Practice, Indianapolis, Indiana.

Jeffrey R. Schein, PhD, MPH

Janssen Medical Affairs, LLC, Titusville, New Jersey.

Mitchell A. Kaplan, PhD

Private Practice, Brooklyn, New York.

Sheri L. Dodd, MSc

Janssen Medical Affairs, LLC, Titusville, New Jersey.

Leah Kleinman, PhD

MEDTAP International, Inc., Seattle, Washington.

Nathaniel P. Katz, MD

Harvard Medical School, Boston, Massachusetts.

Russell K. Portenoy, MD

Beth Israel Medical Center, New York, New York.


Collett BJ: Opioid tolerance: The clinical perspective. Br J Anaesth. 1998; 81: 58-68.

Portenoy RK: Chronic opioid therapy in nonmalignant pain. J Pain Symptom Manage. 1990; 5 (1 Suppl): S46-S62.

Portenoy RK: Opioid therapy for chronic nonmalignant pain and current status. In Fields HL, Liebeskind JC (Eds.): Pain Research and Management, Vol. 1. Seattle: IASP Press, 1994: 247-287.

Urban BJ, France RD, Steinberger EK, et al.: Long-term use of narcotic/antidepressant medication in the management of phantom limb pain. Pain. 1986; 24: 191-196.

Zenz M, Strumpf M, Tryba M: Long-term opiate therapy in patients with chronic nonmalignant pain. J Pain Symptom Manage. 1992; 7: 69-77.

Passik SD, Kirsh KL, Portenoy RK: Substance abuse issues in palliative care. In Berger AM, Portenoy RK, Weissman DE (Eds.): Principles and Practice of Palliative Care and Supportive Oncology, 2nd Ed. Philadelphia: Lippincott Williams & Wilkins, 2002: 593-603.

Passik SD, Weinreb HJ: Managing chronic nonmalignant pain: Overcoming obstacles to the use of opioids. Adv Ther. 2000; 17: 70-80.

Clark JD: Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage. 2002; 23: 131-137.

Federation of State Medical Boards: Model guidelines for the use of controlled substances for the treatment of pain. House of Delegates of the Federation of State Medical Boards of the United States, April, 1998. Available online at:

Passik SD, Kirsh KL, Whitcomb LA, et al.: A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004; 26(4): 552-561.

Cleeland CS: Measurement of pain by subjective report. In Chapman CR, Loeser JD (Eds.): Advances in Pain Research and Therapy, Volume 12: Issues in Pain Measurement. New York: Raven Press, 1989: 391-403.

Brown J, Klapow J, Doleys D, et al.: Disease-specific and generic health outcomes: A model for the evaluation of longterm intrathecal opioid therapy in non-cancer low back pain patients. Clin J Pain. 1999; 15(2): 122-131.

Tollison CD, Kriegel ML, Downie GR: Chronic low back pain: Results of treatment at the Pain Therapy Center. South Med J. 1985; 78(11): 1291-1295.

Hancock CM: OxyContin use and abuse. Clin J Oncol Nurs 2002; 6(2): 109-110.

Hays L, Kirsh KL, Passik SD: Seeking drug treatment for oxycontin abuse: A chart review of consecutive admissions to a substance abuse treatment facility in the bluegrass region of Kentucky. J Natl Compr Canc Netw. 2003; 1(3): 423-428.

Kurz A, Sessler DI: Opioid-induced bowel dysfunction: Pathophysiology and potential new therapies. Drugs. 2003; 63(7): 649-671.

Staats PS, Markowitz J, Schein J: Incidence of constipation associated with long-acting opioid therapy: A comparative study. South Med J. 2004; 97(2): 129-134.

Medina JL, Diamond S: A headache clinic’s experience: Diamond Headache Clinic, Ltd. NIDA Res Monogr. 1981; 36: 130-136.

Porter J, Jick H: Addiction rare in patients treated with narcotics. N Engl J Med. 1980; 302(2): 123.

Cowan DT, Allan L, Griffiths P: A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients. Int J Nurs Stud. 2002; 39(1): 59-69.

Bruera E, Moyano J, Seifert L, et al.: The frequency of alcoholism among patients with pain due to terminal cancer. J Pain Symptom Manage. 1995; 10(8): 599.

Passik SD, Kirsh KL, McDonald MV, et al.: A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients. J Pain Symptom Manage. 2000; 19(4): 274-286.

Colliver JD, Kopstein AN: Trends in cocaine abuse reflected in emergency room episodes reported to DAWN. Publ Health Rep. 1991; 106: 59-68.

Groerer J, Brodsky M: The incidence of illicit drug use in the United States, 1962-1989. Br J Addict. 1992; 87: 1345.

Regier DA, Meyers JK, Dramer M, et al.: The NIMH epidemiologic catchment area program. Arch Gen Psychiatr. 1984; 41: 934.

Nicholson B: Responsible prescribing of opioids for the management of chronic pain. Drugs. 2003; 63(1): 17-32.

Olason M: Outcome of an interdisciplinary pain management program in a rehabilitation clinic. Work. 2004; 22(1): 9-15.




How to Cite

Passik, PhD, S. D., K. L. Kirsh, PhD, L. Whitcomb, MA, J. R. Schein, PhD, MPH, M. A. Kaplan, PhD, S. L. Dodd, MSc, L. Kleinman, PhD, N. P. Katz, MD, and R. K. Portenoy, MD. “Monitoring Outcomes During Long-Term Opioid Therapy for Noncancer Pain: Results With the Pain Assessment and Documentation Tool”. Journal of Opioid Management, vol. 1, no. 5, Nov. 2005, pp. 257-66, doi:10.5055/jom.2005.0055.