McMaster University

Michael G. DeGroote
National Pain Centre

Scope of Search

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

Appendix B-7: Example of Documenting Opioid Therapy

Opioid Therapy Record Example

Date: Jan 13 2010 Mar 23 2010 May 23 2010  
Opioid type Oxycodone Oxycodone    
Opioid dose 20 tid 30 tid    
MEQ dose 90 mg 135    
Pain worst 8 arrow 6    
Pain least 3 3    
Pain average 6 5    
Pain right now 6 arrow 4    
BPI functional improvement Sleep improved Back to work    
Adverse effects Nausea Nausea continues    
Medical complications nil nil    
Compliance UDS clear No concerns    
Action Increase to 30 tid Keep this dose    
Other Comments