Shifting quality chronic pain treatment measures from processes to outcomes


  • Christa Coleman, PsyD, MSCP
  • Robert P. Lennon, MD, JD
  • Rose Hennessy Garza, PhD, MPH
  • Christin Veasley, BS
  • Jay Kuchera, MD
  • Robert Edwards, PhD
  • Aleksandra E. Zgierska, MD, PhD



opioids, treatment, monitoring, chronic pain


Objective: Misapplication of the 2016 Centers for Disease Control (CDC) opioid prescribing guidelines has led to overemphasis of morphine-equivalent daily dose (MEDD) as a “metric of success” in chronic noncancer pain (CNCP), resulting in unintentional harms to patients. This article reviews CNCP-related guidelines and patient preferences in order to identify pragmatic, patient-centered metrics to assess treatment response and safety in opioid-treated CNCP.

Methods: We reviewed the clinical (CDC), research (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials), and implementability-related guidelines (GuideLine Implementability Appraisal), along with relevant patient-identified treatment goals. From these, we summarize a guideline-concordant, patient-centered, implementable set of measures to aid the clinical management of opioid-treated CNCP.

Results: We identify metrics across three domains of care: (1) treatment response metrics, which align with the CNCP care goals (pain intensity, pain interference including function and quality of life, and global impression of change); (2) risk assessment (“safety”) metrics, eg, MEDD, benzodiazepine-opioid or naloxone-opioid coprescribing, and severity of mental health disorders, which evaluate the risk-benefit profile of opioid therapy; and (3) adherence (“process”) metrics, which assess clinician/patient adherence to the guideline-recommended opioid therapy monitoring practices, eg, the presence of completed treatment agreement or urine toxicology testing. All metrics should be informed by implementability principles, eg, be decidable, executable, and measurable.

Conclusions: This article summarizes guideline-concordant, patient-centered, implementable metrics for assessing treatment response, safety, and adherence in opioid-treated CNCP. Regardless of which specific treatment guidelines are applied, this approach could help conceptualize and standardize the collection and reporting of CNCP-relevant metrics, compare them across health systems, and optimize care and treatment outcomes in opioid-treated CNCP.

Author Biographies

Christa Coleman, PsyD, MSCP

Assistant Professor, Departments of Psychiatry and Behavioral Health and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania

Robert P. Lennon, MD, JD

Associate Professor, Department of Family and Community Medicine, Penn State College of Medicine, Hershey; Affiliate Faculty, Penn State Law, University Park, Pennsylvania

Rose Hennessy Garza, PhD, MPH

Visiting Assistant Professor, Joseph J Zilber School of Public Health, University of Wisconsin – Milwaukee, Milwaukee, Wisconsin

Christin Veasley, BS

Co-Founder & Director, Chronic Pain Research Alliance, Milwaukee, Wisconsin

Jay Kuchera, MD

Director, Specialized Opioid Support Services, Resolute Pain Solutions, Envision Physician Services, Port Saint Lucie, Florida

Robert Edwards, PhD

Associate Professor, Department of Anesthesiology, Brigham & Women’s Hospital, Harvard School of Medicine, Boston, Massachusetts

Aleksandra E. Zgierska, MD, PhD

Professor, Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania


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How to Cite

Coleman, C., R. P. Lennon, R. H. Garza, C. Veasley, J. Kuchera, R. Edwards, and A. E. Zgierska. “Shifting Quality Chronic Pain Treatment Measures from Processes to Outcomes”. Journal of Opioid Management, vol. 19, no. 7, Oct. 2023, pp. 83-94, doi:10.5055/jom.2023.0802.

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