1. 2006;9;1-40Opioid Guidelines in the Management of Chronic Non-Cancer Pain
   Opioid Guidelines
   Andrea M. Trescot, MD, Mark V. Boswell, MD, PhD, Sairam L. Atluri, MD, Hans C. Hansen, MD, Timothy R. Deer, MD, Salahadin Abdi, MD, PhD, Joseph F. Jasper, MD, Vijay Singh, MD, Arthur E. Jordan, MD, Benjamin W. Johnson, MD, Roger S. Cicala, MD, Elmer E. Dunbar, MD, Standiford Helm II, MD, Kenneth G. Varley, MD, Praveen K. Suchdev, MD, John R. Swicegood, MD, Aaron K. Calodney, MD, Bentley A. Ogoke, MD, W. Stephen Minore, MD, and Laxmaiah Manchikanti, MD.

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).

Objectives: 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.

Design: 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 scientifi c 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.

Conclusion: 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 scientifi c evidence and do not constitute in-fl exible treatment recommendations. Because of the changing body of evidence, this document is not intended to be a "standard of care."

Key Words: Chronic pain, persistent pain, controlled substances, substance abuse, dependency, prescription accountability, opioids, prescription monitoring, diversion, guidelines