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


Authors: Chou, R.; Fanciullo, G. J.; Fine, P. G.; Adler, J. A.; Ballantyne, J. C.; Davies, P.; Donovan, M. I.; Fishbain, D. A.; Foley, K. M.; Fudin, J.; Gilson, A. M.; Kelter, A.; Mauskop, A.; O'Connor, P. G.; Passik, S. D.; Pasternak, G. W.; Portenoy, R. K.; Rich, B. A.; Roberts, R. G.; Todd, K. H.; Miaskowski, C.
Article Title: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain
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 polices. 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. © 2009 American Pain Society.
Keywords: treatment outcome; constipation; drug dose reduction; drug safety; drug withdrawal; patient selection; side effect; drug megadose; monitoring; low drug dose; pain; nausea; vomiting; qt prolongation; sedation; brain injury; patient monitoring; practice guideline; dose-response relationship, drug; high risk patient; risk assessment; drug dose escalation; pruritus; chronic disease; health care policy; death; patient safety; long term care; medical society; pregnancy; drug monitoring; chronic pain; clinical practice guideline; opioid analgesics; opioids; methadone; morphine; driving ability; drug abuse; drug dose titration; drug half life; heart arrhythmia; hypogonadism; informed consent; low birth weight; mental concentration; myoclonus; prematurity; reflex; respiration depression; somnolence; analgesics, opioid; opioid-related disorders; pain measurement
Journal Title: Journal of Pain
Volume: 10
Issue: 2
ISSN: 1526-5900
Publisher: Churchill Livingstone  
Date Published: 2009-02-01
Start Page: 113
End Page: 130
Language: English
DOI: 10.1016/j.jpain.2008.10.008
PUBMED: 19187889
PROVIDER: scopus
PMCID: PMC4043401
DOI/URL:
Notes: --- - "Cited By (since 1996): 128" - "Export Date: 30 November 2010" - "CODEN: JPOAB" - "Source: Scopus"
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MSK Authors
  1. Steven D Passik
    122 Passik
  2. Kathleen M Foley
    162 Foley
  3. Gavril W Pasternak
    379 Pasternak