Pain Management Resources

Guidelines

• Guidelines for Prescribing Controlled Substances for Pain
  • Medical Board of California, 2014
• Clinical Guidelines for the Use of Chronic Opioid therapy in Chronic Noncancer Pain
  •  American Pain Society-American Academy of Pain Medicine, 2009
• Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline
  • American College of Physicians + American Pain Society, 2007
• CDC Guidelines for Prescribing Opioids for Chronic Pain
  • Centers for Disease Control and Prevention, 2016
• Clinical Guideline for Noninvasive Treatments of Acute, Subacute, and Chronic Low Back Pain
  • American College of Physicians, 2017

Policies

• Primary Care, San Francisco Health Network, Department of Public Health
  • 16.19 Use of Controlled Substances for Chronic Pain Management (2009)
  • Concerning Behavior in the Use of Controlled Substances in the Treatment of Chronic Non-Malignant Pain (2009)
  • Mechanism of annual review: Doses of opioids exceeding 400 mg per day of morphine equivalents or methadone exceeding 100 mg per day in the treatment of chronic non-malignant pain (2011)
• San Francisco Health Plan
  • Pain Program Updates for opioids
  • Proposed Language for Chronic Pain Management Protocols

Non-medication Treatment/Resources

• San Francisco Pain Project
  • Free online map-based tool for patients and providers to identify alternative and complementary pain and addiction management services.
• Low Cost Integrative Medicine for Chronic Pain (2013)
  • List of wellness, acupuncture, massage, meditation, + other treatments available at low cost in San Francisco
• Mindfulness and Guided Meditation Resources
  • Links to programs across the US
• Flare Plan
  • Tool for creating a pain flare plan
• My Personal Care Plan for Chronic Pain
  • Tool for goal setting that includes sleep, physical activity, stress, + pain

Pain Groups

• Behavioral Health Team Chronic Pain Group Manuals (SF DPH Family Health Center)
  • Facilitator and Patient Manuals for 12-week pain group using cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness techniques
• Body and Soul:  A Path Toward Healing from Chronic Pain (SF DPH Family Health Center)
  • Manual for 12-week pain group using cognitive behavioral therapy techniques
• Pain Management and Annual Meeting Handbook (SF DPH Maxine Hall Health Center)
  • Handbook for annual meeting for patients on opioids for education, pain agreement/informed consent, + urine toxicology testing

Opioids

• Opioid Dosing – Clinical Guideline for Safe + Effective Opioid Prescribing (San Francisco Health Plan)
• Opioid Analgesic Converter
  • GlobalRPH website with conversion calculator
• Managing Opioid Withdrawal Symptoms (DPH Tom Waddell Urban Health, 2013)
• Urine Toxicology Testing Questions (DPH Tom Waddell Urban Health)
• Urine Toxicology Interpretation Grid (Zuckerberg San Francisco General Hospital Laboratory, 2013)
  • NOTE:  This information does not apply to urine toxicology tests done elsewhere
• Prescription Drug Monitoring Program (PDMP)/CURES Application Instructions
  • How California prescribers can obtain access to the PDMP/CURES system
• California Department of Justice PDMP Registration
  • Website to register for CURES
• Chronic Pain Assessment and Treatment Plan Template (San Francisco Health Network, 2009)
• Informed Consent/Patient Agreement Templates (San Francisco Health Network, 2009)
  • English
  • Spanish
  • Chinese

Specialty Treatments

• ZSFGH Pain Clinic
  • Pain Consultation and Treatment

Buprenorphine

• Buprenorphine for Pain (2014)
  • Presentation by Michelle Geier, PharmD, SFDPH on buprenorphine, evidence + use for chronic pain

Naloxone Prescribing, Education, and Awareness

• Naloxone for Opioid Safety
  • Provider’s guide to prescribing naloxone to patients who use opioids
• SFDPH Letter of Support for Naloxone Use
  • Letter of support from Barbara Garcia, Director of Health, to prescribe naloxone to patients who use opioids
• Opioid Safety and How to Use Naloxone
  • Guide for patients + caregivers
• Naloxone Administration for Opioid Overdose
  • You Tube video demonstrating intranasal naloxone use by Michelle Geier, PharmD, SFDPH
• Overdose Treatment Liability Act
  • Assembly Bill 635 expanding availability + distribution of naloxone in California
• Naloxone Good Samaritan Bill
  • Assembly Bill 472 -Witnesses of an overdose who seek medical help given legal protection from arrest/prosecution for minor drug/alcohol violations.
• Pharmacy Provision Bill 
  • Assembly Bill 1535-Pharmacists are allowed to directly prescribe and dispense naloxone to patients at risk of experiencing or witnessing an opioid overdose.
• Prescribe to Prevent
  •  Website with information to prescribe + dispense naloxone
• Harm Reduction Coalition – Overdose Prevention
  • Website with general overdose prevention information
• Naloxone Pharmacy Guidelines/Access
  • How to order + bill for naloxone in California

Substance Use Disorders

• SBIRT Pocket Card, DSM IV (Zuckerberg San Francisco General Hospital)
  • Screening, Brief Intervention, + Referral to Treatment for alcohol + drug use (DSM IV)
• SBIRT Pocket Card, DSM V (Zuckerberg San Francisco General Hospital)
  • Screening, Brief Intervention, + Referral to Treatment for alcohol + drug use (DSM V)
• Opioid Treatment Programs (2013)
  •  List of programs in San Francisco

Patient Information

•  Taking Charge Living Life
  • Brochure from San Francisco Health Plan
• Pain Management Tools from The American Chronic Pain Association
• Chronic Pain Breathing (SF DPH Tom Waddell Urban Health, 2016)
• Gentle Movement Poses to do at Home for Chronic Pain (SF DPH Tom Waddell Urban Health, 2016)
• What is Chronic Pain? (SF DPH Tom Waddell Urban Health, 2016)
•  Concerning Behavior/Urine Testing flier (SF DPH Tom Waddell Urban Health, 2016)
  • Handout about opioid safety around concerning behaviors and urine testing
• The 4-7-8 (or Relaxing Breath) Exercise
  • Handout with simple breathing exercise
• Guide to Free and Low-Cost Integrative Medicine Resources
  • Pain Management Resources in San Francisco areas

Other San Francisco Health Plan Pain Management Resources here.

Contact Information

• Paula Lum, MD, MPH, Positive Health Program, HIV/AIDS Division, UCSF/SFGH, paula.lum@ucsf.edu, phone (415) 476 4082 x811
• Barbara Wismer, MD, MPH, Tom Waddell Urban Health, barbara.wismer@sfdph.org, phone (415) 355 7426
• Daniel Wlodarczyk, MD, Positive Health Program/Southeast Health Center, DWlodarczyk@php.ucsf.edu – documentation in eClinicalWorks, using i2i Tracks for registries, committees to address concerning behaviors
• SFGH Clinical Chemistry/Toxicology Fellow – available Monday – Friday, 9 am – 5 pm; call the Clinical Laboratory Information Section, 206-8590 to contact the fellow on call for consultation regarding toxicology questions.  At all other times, call the Clinical Laboratory Information Section, 206-8590, to contact the Resident on-call.
• San Francisco Health Plan, pain@sfhp.org – feedback email for any questions regarding pain (SFHP program, pharmacy, training requests, general questions)

• Providers Clinical Support System for Opioid Therapies, pcss-o.org–National training and mentoring project developed in response to the prescription opioid overdose epidemic

Last update January 2017 Not responsible for the content of any links on this page Maintained by the San Francisco Safety Net Pain Management Work Group