Article

Opioid guidelines in the management of chronic non-cancer pain

American Society of Interventional Pain Physicians, Paducah, KY 42001, USA.
Pain physician (Impact Factor: 4.77). 02/2006; 9(1):1-39.
Source: PubMed

ABSTRACT Opioid abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of opioids, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration (DEA).
The objective of these opioid guidelines by the American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of drug diversion.
A policy committee evaluated a systematic review of the available literature regarding opioid use in managing chronic non-cancer pain. This resulted in the formulation of the essentials of guidelines, a series of potential evidence linkages representing conclusions, followed by statements regarding relationships between clinical interventions and outcomes.
Consistent with the Agency for Healthcare Research and Quality (AHRQ) hierarchical and comprehensive standards, the elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentations, formal endorsement by the Board of Directors of the American Society of Interventional Pain Physicians (ASIPP), and blinded peer review. Evidence was designated based on scientific merit as Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), or Level V (indeterminate).
After an extensive review and analysis of the literature, the authors utilized two systematic reviews, two narrative reviews, 32 studies included in prior systematic reviews, and 10 additional studies in the synthesis of evidence. The evidence was limited.
These guidelines evaluated the evidence for the use of opioids in the management of chronic non-cancer pain and recommendations for management. These guidelines are based on the best available scientific evidence and do not constitute inflexible treatment recommendations. Because of the changing body of evidence, this document is not intended to be a "standard of care."

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Available from: Andrea M Trescot, Aug 29, 2015
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    • "Opioids are often prescribed for chronic pain but their utility is frequently limited by their gastrointestinal (GI) side effects. For instance, constipation is known to occur in 15-90% of patients receiving opiates and is known to have a negative impact on health related quality of life (QOL).1 Whilst the long-term use of opiates in patients with chronic non-cancer pain escalates, evidence suggests that opiates fail to fulfil any of the key outcomes in terms of adequate pain relief, improved QOL or improvements in functional capacity.2,3 "
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    • "Although the therapeutic use of the opioids in the management of pain has long been established and opioids may even be underutilized at times (Ballantyne, 2007; Trescot et al., 2006, 2008) there is also growing concern that over the last two decades, there has been a large increase in the prevalence of prescription opioid use disorders (Blanco et al., 2007; Cicero and Inciardi, 2005; Compton and Volkow, 2006; McCabe, 2005; Rigg and Ibanez, 2000; Zacny et al., 2003). It is estimated that the 12-month prevalence of prescription opioid use disorders is 0.30% (Blanco et al., 2007), affecting over one million adults in the US (Grant et al., 2004b). "
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    • "To lessen the harm associated with drug abuse, there must be strict measures in place for improving physician awareness, supporting treatment for drug dependence, appropriate prescribing practices of medications by physicians, and identifying patients through prescription-monitoring programs who are getting multiple prescriptions.14 Further, clinicians need strategies to better adhere to chronic pain management guidelines, and counsel their patients about the risk of opioid drug overdose.32 "
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