APS American Pain Society. Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. "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."
The Journal of Pain - February 2009 (Vol. 10, Issue 2, Pages 113-130.e22, DOI: 10.1016/j.jpain.2008.10.008)
ASIPP American Society of the Interventional Pain Physicians’. Opioids in the Management of Chronic Non-Cancer Pain. "Opioid abuse has continued to increase at an alarming rate since our last opioid guidelines were published in 2005. Available evidence suggests a continued wide variance in the use of opioids, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration." "The objectives of opioid guidelines by the American Society of Interventional Pain Physicians (ASIPP) are 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 abuse and drug diversion."
Pain Physician Journal- 2008 (Pages S5-S62, Opioids Special Issue: 11:S5-S62 • ISSN 1533-3159)
FSMB Federation of State Medical Boards. Model Policy for the Use of Controlled Substances for the Treatment of Pain "Since adoption in April 1998, the Model Guidelines for the Use of Controlled Substances for the Treatment of Pain have been widely distributed to state medical boards, medical professional organizations, other health care regulatory boards, patient advocacy groups, pharmaceutical companies, state and federal regulatory agencies, and practicing physicians and other health care providers. The Model Guidelines have been endorsed by the American Academy of Pain Medicine, the Drug Enforcement Administration, the American Pain Society, and the National Association of State Controlled Substances Authorities. Many states have adopted pain policy using all or part of the Model Guidelines. Despite increasing concern in recent years regarding the abuse and diversion of controlled substances, pain policies have improved due to the efforts of medical, pharmacy, and nursing regulatory boards committed to improving the quality of and access to appropriate pain care."
Federation of State Medical Boards of the United States Model policy for the use of controlled substances for the treatment of pain. Euless, TX: 2004.
VA Veterans Affairs. Evidence-Based Practice- Management of Opioid Therapy for Chronic Pain "Chronic pain, which can be caused by many medical conditions and syndromes with different pathophysiologies, is an important and common medical concern worldwide. In the United States, pain is the most common complaint that leads patients to seek medical care. Although opioid use for acute/postsurgical pain and for palliative care is accepted in the United States, controversy continues among pain practitioners concerning the use of opioids for the treatment of chronic pain. More recently, this controversy has resurfaced, in part through press and media reports of opioid medication abuse and alleged practitioner misconduct." "Opioid treatment of pain has been, and remains, severely hampered because of actual and legal constraints related to substance abuse and diversion. The guideline algorithm and recommendations suggest a structured goal-directed approach to chronic opioid treatment, which aims to select and monitor patients carefully, and wean therapy if treatment goals are not reached."
VA/DoD Evidence-Based Practice- Management of Opioid Therapy for Chronic Pain - May 2010.