Pain Management Tools

The HUSKY Health program is committed to providing support to CMAP providers. Please utilize the following tools to assist with the assessment and treatment of patients with chronic pain conditions.


Pain Assessment Tools

There are a number of pain assessment tools that can be used to evaluate a patient’s pain and current level of function. HUSKY Health recommends the use of the following pain assessment tools:

  • Brief Pain Inventory – Short Version: The Brief Pain Inventory – Short Version is a brief nine question survey which asks patients to rate their pain and also assesses the patient’s ability to complete activities of daily living.
  • Brief Pain Inventory - Long Version: The Brief Pain Inventory – Long Version is a twenty-three question survey similar to the Brief Pain Inventory – Short Version which contains additional descriptive items that may be clinically useful in the assessment and management of chronic pain.
  • PainEDU Sample Pain Assessment: The PainEDU Sample Pain Assessment utilizes pain scales and questions to assist with the completion of a thorough pain assessment.
  • McAffrey Initial Pain Assessment Tool: The McCaffrey Initial Pain Assessment Tool can be used to guide healthcare professionals through an initial assessment of patient pain.

Opioid Risk Assessment Tools

There are various standardized opioid risk assessment tools that can be used to evaluate a patient’s risk of aberrant drug-related behavior. HUSKY Health recommends the use of the following risk assessment tools, some of which require registration to access:

  • The Screener and Opioid Assessment for Patients with Pain (SOAPP®): The Screener and Opioid Assessment for Patients with Pain (SOAPP®) is a brief tool which may be used to assist in the assessment and management of patients in chronic pain being considered for long-term opiate treatment.
  • Opioid Risk Tool (ORT): The Opioid Risk Tool (ORT) is a brief, self-report screening tool designed for use with adults in the primary care setting to assess for risk of future opioid abuse among individuals prescribed opioids for the treatment of chronic pain.
  • Diagnosis, Intractability, Risk and Efficacy (DIRE) Score Tool: The DIRE Score Tool, developed by Miles Belgrade, MD, is designed to assess the probability of success or risk of opioid analgesia in patients with chronic pain conditions.
  • Pain Assessment and Documentation Tool (PADT™): The Pain Assessment and Documentation Tool (PADT™) is designed to be easily included in the medical record and to facilitate ongoing evaluation of pain-related outcomes.
  • Current Opioid Misuse Measure (COMM™): The Current Opioid Misuse Measure (COMM™) is a tool which may be used to identify whether a patient, currently on long-term opioid therapy, is exhibiting signs of opiate misuse.

Patient Agreement Forms

Opioid Agreements are documents negotiated between patients and their healthcare providers. The agreements specify patient obligations and responsibilities, along with prescriber policies, such as those concerning prescription refills and urine drug monitoring.

  • Sample Patient Agreement Forms: This resource includes two sample patient agreement forms that can be used with patients who are beginning long-term treatment with opioid analgesics or other controlled substances.

Sample Informed Consent Form

Sample Informed Consent Form: This sample informed consent form is for use with patients who are beginning long-term therapy with opioid analgesics to help ensure they understand the side effects, risks, conditions, and purpose of their treatment.

Pain Diary

Daily Pain Diary

Sample Notification of Discontinuation of Opioid Treatment Form

  • Sample Notification of Discontinuation of Opioid Treatment Form: A critical component of treatment is recognizing when to taper and/or transition a patient off of opioid-based medications. Providing this sample letter to your patient allows you to document why opioid treatment can no longer be provided and gives you the opportunity to provide the patient with information about addiction treatment services.

This portion of the HUSKY Health website is managed by Community Health Network of Connecticut, Inc., the State of Connecticut’s Medical Administrative Services Organization for the HUSKY Health Program. For the general HUSKY website gateway, please visit www.ct.gov/husky. HUSKY Health includes Medicaid and the Children’s Health Insurance Program, and is administered by the Connecticut Department of Social Services.