The American Society of Interventional Pain Physicians (ASIPP) has issued updated opioid prescribing guidelines for the management of patients with chronic, non-cancer pain. The guidelines are available in the current issue of Pain Physician.
Experts in a variety of medical fields were brought in by ASIPP to review available evidence and create recommendations “to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique.” Each recommendation is graded based on the quality and strength of evidence. For example, a recommendation with an evidence level of I is considered strong because it was made based on evidence from multiple relevant high quality randomized controlled trials. In contrast, a statement with an evidence level of V would indicate that the recommendation was based on opinion or by consensus of a large group of clinicians and/or scientists.
When initiating opioid therapy, the panel recommends the following:
- Comprehensive assessment and documentation (ie, general medical history, psychiatric status, substance use history) (Evidence: Level I; Strong)
- Screen for opioid abuse to identify abusers (Evidence: Level II-III; Moderate)
- Implement Prescription Drug Monitoring Programs (PDMPs) which provide patterns of prescription use (Evidence: Level I-II; Moderate to strong)
- Implement urine drug testing (UDT) at the start, use for adherence monitoring or abuse detection (Evidence: Level II; Moderate)
- If available, establish physical and psychological diagnoses before starting treatment (Evidence: Level I; Strong)
- Consider appropriate imaging, physical diagnosis, and psychological status before establishing therapy with opioids (Evidence: Level II; Moderate)
- Medical necessity should be established before starting or maintaining opioid therapy (Evidence: Level I; Strong)
- Stratify patients based on risk (Evidence: Level I-II; Moderate)
- Establish treatment goals (ie, pain relief, functional improvement) (Evidence: Level I-II; Moderate)