Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

Roger Chou, Gilbert J. Fanciullo, Perry G. Fine, Jeremy A. Adler, Jane C. Ballantyne, Pamela Davies, Marilee I. Donovan, David A Fishbain, Kathy M. Foley, Jeffrey Fudin, Aaron M. Gilson, Alexander Kelter, Alexander Mauskop, Patrick G. O'Connor, Steven D. Passik, Gavril W. Pasternak, Russell K. Portenoy, Ben A. Rich, Richard G. Roberts, Knox H. ToddChristine Miaskowski

Research output: Contribution to journalArticle

1446 Citations (Scopus)

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 polices. Perspective: 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.

Original languageEnglish
JournalJournal of Pain
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2009

Fingerprint

Chronic Pain
Opioid Analgesics
Guidelines
Therapeutics
Breakthrough Pain
Patient-Centered Care
Clinical Competence
Methadone
Risk Management
Physiologic Monitoring
Police
Informed Consent
Patient Selection

Keywords

  • chronic pain
  • Clinical practice guideline
  • monitoring
  • opioid analgesics
  • opioids
  • risk assessment

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Chou, R., Fanciullo, G. J., Fine, P. G., Adler, J. A., Ballantyne, J. C., Davies, P., ... Miaskowski, C. (2009). Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. Journal of Pain, 10(2). https://doi.org/10.1016/j.jpain.2008.10.008

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. / Chou, Roger; Fanciullo, Gilbert J.; Fine, Perry G.; Adler, Jeremy A.; Ballantyne, Jane C.; Davies, Pamela; Donovan, Marilee I.; Fishbain, David A; Foley, Kathy M.; Fudin, Jeffrey; Gilson, Aaron M.; Kelter, Alexander; Mauskop, Alexander; O'Connor, Patrick G.; Passik, Steven D.; Pasternak, Gavril W.; Portenoy, Russell K.; Rich, Ben A.; Roberts, Richard G.; Todd, Knox H.; Miaskowski, Christine.

In: Journal of Pain, Vol. 10, No. 2, 01.02.2009.

Research output: Contribution to journalArticle

Chou, R, Fanciullo, GJ, Fine, PG, Adler, JA, Ballantyne, JC, Davies, P, Donovan, MI, Fishbain, DA, Foley, KM, Fudin, J, Gilson, AM, Kelter, A, Mauskop, A, O'Connor, PG, Passik, SD, Pasternak, GW, Portenoy, RK, Rich, BA, Roberts, RG, Todd, KH & Miaskowski, C 2009, 'Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain', Journal of Pain, vol. 10, no. 2. https://doi.org/10.1016/j.jpain.2008.10.008
Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P et al. Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. Journal of Pain. 2009 Feb 1;10(2). https://doi.org/10.1016/j.jpain.2008.10.008
Chou, Roger ; Fanciullo, Gilbert J. ; Fine, Perry G. ; Adler, Jeremy A. ; Ballantyne, Jane C. ; Davies, Pamela ; Donovan, Marilee I. ; Fishbain, David A ; Foley, Kathy M. ; Fudin, Jeffrey ; Gilson, Aaron M. ; Kelter, Alexander ; Mauskop, Alexander ; O'Connor, Patrick G. ; Passik, Steven D. ; Pasternak, Gavril W. ; Portenoy, Russell K. ; Rich, Ben A. ; Roberts, Richard G. ; Todd, Knox H. ; Miaskowski, Christine. / Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. In: Journal of Pain. 2009 ; Vol. 10, No. 2.
@article{b0ae890e673d413e9976fbf61c89df06,
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 polices. Perspective: 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.",
keywords = "chronic pain, Clinical practice guideline, monitoring, opioid analgesics, opioids, risk assessment",
author = "Roger Chou and Fanciullo, {Gilbert J.} and Fine, {Perry G.} and Adler, {Jeremy A.} and Ballantyne, {Jane C.} and Pamela Davies and Donovan, {Marilee I.} and Fishbain, {David A} and Foley, {Kathy M.} and Jeffrey Fudin and Gilson, {Aaron M.} and Alexander Kelter and Alexander Mauskop and O'Connor, {Patrick G.} and Passik, {Steven D.} and Pasternak, {Gavril W.} and Portenoy, {Russell K.} and Rich, {Ben A.} and Roberts, {Richard G.} and Todd, {Knox H.} and Christine Miaskowski",
year = "2009",
month = "2",
day = "1",
doi = "10.1016/j.jpain.2008.10.008",
language = "English",
volume = "10",
journal = "Journal of Pain",
issn = "1526-5900",
publisher = "Churchill Livingstone",
number = "2",

}

TY - JOUR

T1 - Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

AU - Chou, Roger

AU - Fanciullo, Gilbert J.

AU - Fine, Perry G.

AU - Adler, Jeremy A.

AU - Ballantyne, Jane C.

AU - Davies, Pamela

AU - Donovan, Marilee I.

AU - Fishbain, David A

AU - Foley, Kathy M.

AU - Fudin, Jeffrey

AU - Gilson, Aaron M.

AU - Kelter, Alexander

AU - Mauskop, Alexander

AU - O'Connor, Patrick G.

AU - Passik, Steven D.

AU - Pasternak, Gavril W.

AU - Portenoy, Russell K.

AU - Rich, Ben A.

AU - Roberts, Richard G.

AU - Todd, Knox H.

AU - Miaskowski, Christine

PY - 2009/2/1

Y1 - 2009/2/1

N2 - 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 polices. Perspective: 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.

AB - 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 polices. Perspective: 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.

KW - chronic pain

KW - Clinical practice guideline

KW - monitoring

KW - opioid analgesics

KW - opioids

KW - risk assessment

UR - http://www.scopus.com/inward/record.url?scp=58949087497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58949087497&partnerID=8YFLogxK

U2 - 10.1016/j.jpain.2008.10.008

DO - 10.1016/j.jpain.2008.10.008

M3 - Article

C2 - 19187889

AN - SCOPUS:58949087497

VL - 10

JO - Journal of Pain

JF - Journal of Pain

SN - 1526-5900

IS - 2

ER -