The American Society of Interventional Pain Physicians (ASIPP), a not-for-profit organization representing nearly 4,500 interventional pain management specialists, has issued updated guidelines for managing patients with chronic, non-cancer pain in an effort to help curb the growing prescription drug epidemic in the U.S. Powerful opioid painkillers are the most abused and misused prescription drug in the country.
The guidelines, published in the journal Pain Physician, were drafted by experts representing a variety of medical fields in an effort to “provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique.”
The recommendations are based on several relevant high quality randomized controlled trials and/or a consensus of opinions of a large group of clinicians and/or scientists. Here are some highlights of the new guidelines for physicians when initiating opioid therapy:
- Conduct a comprehensive assessment including general medical history, psychiatric status and substance abuse history.
- Screen for opioid abuse to identify abusers.
- Implement urine drug testing at the start, and use for adherence monitoring or abuse detection.
- Establish a physical and psychological diagnoses before starting treatment.
- Establish medical necessity before starting or maintaining opioid therapy.
Once the decision has been made to initiate opioid therapy, the ASIPP recommends physicians do the following:
- Initiate therapy with low doses and short-acting drugs with appropriate monitoring.
- Do not use long-acting opioids as initial therapy.
- Methadone use should be limited to patients who have failed other opioid therapies and only by those specifically trained in prescribing it within FDA-approved indications.
- Educate patients on the efficacy, adverse effects, and limitations of long-term opioid therapy.
The panel added that “chronic opioid therapy should be provided only to patients with proven medical necessity and stability with improvement in pain and function, independently or in conjunction with other modalities of treatments in low doses with appropriate adherence monitoring and understanding of adverse events.”