title: Opioid guidelines in the management of chronic non-cancer pain.
abstract: BACKGROUND
  Opioid abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of opioids, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration (DEA).
  
  
  OBJECTIVE
  The objective of these opioid guidelines by the American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of drug diversion.
  
  
  METHODS
  A policy committee evaluated a systematic review of the available literature regarding opioid use in managing chronic non-cancer pain. This resulted in the formulation of the essentials of guidelines, a series of potential evidence linkages representing conclusions, followed by statements regarding relationships between clinical interventions and outcomes.
  
  
  METHODS
  Consistent with the Agency for Healthcare Research and Quality (AHRQ) hierarchical and comprehensive standards, the elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentations, formal endorsement by the Board of Directors of the American Society of Interventional Pain Physicians (ASIPP), and blinded peer review. Evidence was designated based on scientific merit as Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), or Level V (indeterminate).
  
  
  RESULTS
  After an extensive review and analysis of the literature, the authors utilized two systematic reviews, two narrative reviews, 32 studies included in prior systematic reviews, and 10 additional studies in the synthesis of evidence. The evidence was limited.
  
  
  CONCLUSIONS
  These guidelines evaluated the evidence for the use of opioids in the management of chronic non-cancer pain and recommendations for management. These guidelines are based on the best available scientific evidence and do not constitute inflexible treatment recommendations. Because of the changing body of evidence, this document is not intended to be a "standard of care."
authors.affiliation: American Society of Interventional Pain Physicians, Paducah, KY 42001, USA. amt57@aol.com
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Trescot
authors.forename: Mark V
authors.initials: MV
authors.lastname: Boswell
authors.forename: Sairam L
authors.initials: SL
authors.lastname: Atluri
authors.forename: Hans C
authors.initials: HC
authors.lastname: Hansen
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Deer
authors.forename: Salahadin
authors.initials: S
authors.lastname: Abdi
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Jasper
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Jordan
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Johnson
authors.forename: Roger S
authors.initials: RS
authors.lastname: Cicala
authors.forename: Elmer E
authors.initials: EE
authors.lastname: Dunbar
authors.forename: Standiford
authors.initials: S
authors.lastname: Helm
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Varley
authors.forename: P K
authors.initials: PK
authors.lastname: Suchdev
authors.forename: John R
authors.initials: JR
authors.lastname: Swicegood
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Calodney
authors.forename: Bentley A
authors.initials: BA
authors.lastname: Ogoke
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Minore
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use*; D002908:Chronic Disease; D016903:Drug Monitoring / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology; D010147:Pain Measurement; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid