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Practice Guideline
. 2009 Feb;10(2):113-30.
doi: 10.1016/j.jpain.2008.10.008.

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain

Roger Chou  1 , Gilbert J Fanciullo, Perry G Fine, Jeremy A Adler, Jane C Ballantyne, Pamela Davies, Marilee I Donovan, David A Fishbain, Kathy M Foley, Jeffrey Fudin, Aaron M Gilson, Alexander Kelter, Alexander Mauskop, Patrick G O'Connor, Steven D Passik, Gavril W Pasternak, Russell K Portenoy, Ben A Rich, Richard G Roberts, Knox H Todd, Christine Miaskowski; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel
Affiliations
Practice Guideline

Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain

Roger Chou et al. J Pain. 2009 Feb.

Abstract

Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related policies.

Perspective: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.

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References

    1. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104:570–587. - PubMed
    1. Arnold RM, Han PK, Seltzer D. Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties. Am J Med. 2006;119:292–296. - PubMed
    1. Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high-dose opioids. J Opioid Manag. 2006;2:277–282. - PubMed
    1. Belgrade MJ, Schamber CD, Lindgren BR. The DIRE score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006;7:671–681. - PubMed
    1. Benjamin L, Dampier C, Jacox A, Odesina V, Phoenix D, Shapiro B, Strafford M, Treadwell M. Guideline for the management of acute and chronic pain in sickle-cell disease. 2008

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