New Opioid Prescribing Guidelines

A panel of experts from the American Pain Society (APS) and American Academy of Pain Medicine (AAPM) has issued a new set of clinical guidelines aimed at aiding clinicians with prescribing opioids for patients with chronic non-cancer related pain. Panel co-chair Gilbert J. Fanciullo, MD, stated in a press release that the experts concluded “that opioid pain medications are safe and effective for carefully selected, well-monitored patients with chronic non-cancer pain.”

Published in the February issue of The Journal of Pain, the guidelines were established by reviewing more than 8,000 published abstracts and non-published studies. The review was conducted particularly because opioid prescribing has “increased significantly due to growing professional acceptance that the drugs can relieve chronic non-cancer pain, and the guideline acknowledges there are widespread concerns about increases in prescription opioid abuse, addiction and diversion.” The panel made 25 recommendations with unanimous support for almost all. The recommendations covered patient selection and risk stratification, high-risk patients, methadone, informed consent and opioid management plans, patient monitoring, and other topics.

Panel co-chair Perry Fine, MD, emphasized that “Decisions about chronic opioid therapy must weigh the benefits of these medications against the risks, which include side effects and adverse outcomes associated with abuse.”

The key recommendation advocates that clinicians “continuously assess patients on chronic opioid therapy by monitoring pain intensity, level of functioning and adherence to prescribed treatments. Periodic drug screens should be ordered for patients at risk for aberrant drug behavior.”

“Regular monitoring of chronic opioid therapy patients is warranted because the therapeutic benefits of these medications are not static and can be affected by changes in the underlying pain condition, coexisting disease, or in psychological or social circumstances,” explained Fanciullo. “For patients at low risk for adverse outcomes and on stable doses of opioids, monitoring at least once every three to six months is sufficient, but weekly monitoring is justifiable for those at high risk for abuse and other adverse events.”

Additionally, Fine pointed out that self reports provided by patients can often be unreliable and should be cross-checked with urine drug screenings, pill counts, and caregiver interviews to ensure there is no possibility for drug abuse.

For the full text of the APS/AAPM clinical guidelines, please click here.

specialty: pain management