title: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain.
abstract: Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related policies.
  
  
  CONCLUSIONS
  Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.
authors.affiliation: Oregon Evidence-based Practice Center, Department of Medicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA. chour@ohsu.edu
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Fanciullo
authors.forename: Perry G
authors.initials: PG
authors.lastname: Fine
authors.forename: Jeremy A
authors.initials: JA
authors.lastname: Adler
authors.forename: Jane C
authors.initials: JC
authors.lastname: Ballantyne
authors.forename: Pamela
authors.initials: P
authors.lastname: Davies
authors.forename: Marilee I
authors.initials: MI
authors.lastname: Donovan
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Foley
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fudin
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gilson
authors.forename: Alexander
authors.initials: A
authors.lastname: Kelter
authors.forename: Alexander
authors.initials: A
authors.lastname: Mauskop
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Connor
authors.forename: Steven D
authors.initials: SD
authors.lastname: Passik
authors.forename: Gavril W
authors.initials: GW
authors.lastname: Pasternak
authors.forename: Russell K
authors.initials: RK
authors.lastname: Portenoy
authors.forename: Ben A
authors.initials: BA
authors.lastname: Rich
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roberts
authors.forename: Knox H
authors.initials: KH
authors.lastname: Todd
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid