Evaluating the Effectiveness of Opioid-based Therapy: Implementing the New APS/AAPM Guidelines for Opioids in Chronic Noncancer Pain

Perry G. Fine, MD

Professor of Anesthesiology
School of Medicine, Pain Research and Management Center
University of Utah
Salt Lake City, Utah
Senior Fellow for Medical Leadership
National Hospice and Palliative Care Organization
Alexandria, Virginia

Abstract: Opioids are an invaluable class of analgesics for acute pain, pain associated with such terminal conditions as cancer, and chronic noncancer pain. The lack of studies evaluating comparative effectiveness and risk during long-term treatment in varied populations and recent increases in prescription opioid abuse, however, necessitate an iterative, structured approach to patient selection, risk stratification, and long-term monitoring of patients outcomes. To aide in this process, the American Pain Society and American Academy of Pain Medicine have recently published guidelines for the use of opioids in noncancer pain. These guidelines stress the importance of applying evidence-based medicine, whenever possible, defining patient-specific treatment goals (eg, pain relief, improved function, better social interactions), and assessing outcomes in relation to these goals to evaluate the effectiveness of the opioid-based treatment regimen.

References

Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-130.
Chou R, Fanciullo GJ, Fine PG, et al. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009;10:131-146.
Martell BA, O'Connor PG, Kerns RD, et al. Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146:116-127.

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