AAPM 2009: New Opioid Clinical Practice Guidelines Published

Allison Gandey

February 12, 2009

February 12, 2009 (Honolulu, Hawaii) — A panel of pain-management experts has published the first comprehensive clinical practice guidelines on opioids for the treatment of chronic noncancer pain. The guidelines, which were 2 years in the making, are from the American Pain Society and the American Academy of Pain Medicine and appear in the February issue of the Journal of Pain.

"The expert panel concluded that opioid pain medications are safe and effective for carefully selected, well-monitored patients with chronic noncancer pain," cochair Gilbert Fanciullo, MD, from the Dartmouth Hitchcock Medical Center, in Lebanon, New Hampshire, said in a news release.

The guidelines were first presented January 28 at the American Academy of Pain Medicine 25th Annual Meeting. Medscape Neurology & Neurosurgery spoke with presenter and cochair Perry Fine, MD, from University of Utah Medical Center, in Salt Lake City.

"This is the first time these issues have been codified in this way," Dr. Fine said. "Of the many issues we tried to confront, key points include the importance of a therapeutic trial, justification for long-term therapy, and continuous reevaluation."

The panel made 25 specific recommendations and reportedly achieved unanimous consensus on nearly all. The group reviewed more than 8000 published abstracts and nonpublished studies to assess clinical evidence.

Weighing the Benefits and Risks

"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," Dr. Fine said.

Opioids such as morphine, oxycodone, oxymorphone, and fentanyl are potent analgesics. They traditionally have been used to relieve pain following surgery, from cancer, and at the end of life. Today, opioids are used widely to relieve severe pain caused by chronic low-back injury, accident trauma, arthritis, sickle cell, fibromyalgia, and other painful conditions.

"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," Dr. Fanciullo said.

American Pain Society President Charles Inturrisi, PhD, called the work a milestone collaboration between 2 leading organizations representing pain management.

"This was a big concerted effort," Ajay Wasan, MD, from Harvard Medical School and Brigham and Women's Hospital, in Boston, Massachusetts, said during an interview. Dr. Wasan moderated the session where the guidelines were first presented. "The committee should be commended on an outstanding job."

Dr. Fanciullo reports that he has financial relationships with Medtronic, Janssen, Teva Pharmaceuticals, and Pfizer. Dr. Fine reports that he has financial ties to Alpharma, Cephalon, Endo Pharmaceuticals, GlaxoSmithKline, Lilly, Merck, Ortho-McNeil, Purdue, and Wyeth.

J Pain. 2009;10:131-146. Abstract


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