TY - JOUR
T1 - Responsible, safe, and effective prescription of opioids for chronic non-cancer pain
T2 - American society of interventional pain physicians (ASIPP) guidelines
AU - Manchikanti, Laxmaiah
AU - Kaye, Adam M.
AU - Knezevic, Nebojsa Nick
AU - McAnally, Heath
AU - Trescot, Andrea M.
AU - Blank, Susan
AU - Pampati, Vidyasagar
AU - Abdi, Salahadin
AU - Grider, Jay S.
AU - Kaye, Alan D.
AU - Manchikanti, Kavita N.
AU - Cordner, Harold J.
AU - Gharibo, Christopher G.
AU - Harned, Michael E.
AU - Albers, Sheri L.
AU - Atluri, Sairam
AU - Aydin, Steve M.
AU - Bakshi, Sanjay
AU - Barkin, Robert
AU - Benyamin, Ramsin M.
AU - Boswell, Mark V.
AU - Buenaventura, Ricardo M.
AU - Calodney, Aaron K.
AU - Cedeno, David L.
AU - Datta, Sukdeb
AU - Deer, Timothy R.
AU - Fellows, Bert
AU - Galan, Vincent
AU - Grami, Vahid
AU - Hansen, Hans
AU - Helm, Standiford
AU - Justiz, Rafael
AU - Koyyalagunta, Dhanalakshmi
AU - Malla, Yogesh
AU - Navani, Annu
AU - Nouri, Kent
AU - Pasupuleti, Ramarao
AU - Sehgal, Nalini
AU - Silverman, Sanford M.
AU - Simopoulos, Thomas T.
AU - Singh, Vijay
AU - Slavin, Konstantin V.
AU - Solanki, Daneshvari R.
AU - Staats, Peter S.
AU - Vallejo, Ricardo
AU - Wargo, Bradley W.
AU - Watanabe, Arthur
AU - Hirsch, Joshua A.
N1 - Funding Information:
There was no external funding in the preparation of this manuscript. Internal funding provided by the American Society of Interventional Pain Physicians (ASIPP) was limited to travel and lodging expenses of the authors.
Funding Information:
contradictory evidence with lack of effectiveness (507-516). These reports have been extensively criticized for their inappropriate analysis, confluence of interest, and finally, inappropriate classification of local anesthetics as placebo agents (415,416,487-491,511-514). However, the studies performed abroad supported by governmental funding (520-522) from the National Health Services (NHS) and Health Technology Assessment (HTA) program have presented positive results for epidural injections, in contrast to AHRQ-sponsored studies (520,521). In NHS and HTA sponsored studies, Lewis et al (513-520) showed the effectiveness of epidural corticosteroid injections. They (521) also showed the superiority of epidural injections to traction, percutaneous discectomy, and exercise therapy. Evidence based on best evidence synthesis ranged from Level II to III in managing multiple pathologies in the lumbar, cervical, and thoracic spine.
Publisher Copyright:
© 2017, American Society of Interventional Pain Physicians. All rights reserved.
PY - 2017/2
Y1 - 2017/2
N2 - Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).
AB - Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).
UR - http://www.scopus.com/inward/record.url?scp=85016172210&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85016172210&partnerID=8YFLogxK
M3 - Article
C2 - 28226332
AN - SCOPUS:85016172210
SN - 1533-3159
VL - 20
SP - S3-S92
JO - Pain physician
JF - Pain physician
IS - 2
ER -