Report: Chronic Pain Treatment Guidelines Mostly Agree
Current guidance includes similar risk-mitigation strategies (November 13)
Current guidelines generally agree on the precautions that doctors can take when prescribing opioids for the treatment of chronic pain, according to a new study published in the Annals of Internal Medicine.
Because of the potential for addiction, misuse, and accidental overdose, opium-related drugs, such as oxycodone and methadone, are usually prescribed for only a week or two for intense short-term pain, although long-term treatment is becoming more prevalent.
To evaluate current guidelines on the use of opioids for chronic pain, researchers reviewed Medline, national and international guideline clearinghouses, and specialty society Web sites. Guidelines published between January 2007 and July 2013 addressing the use of opioids for chronic pain in adults were selected, and guidelines on specific settings, populations, and conditions were excluded.
The researchers found that most guidelines recommend that clinicians avoid doses greater than 90 to 200 mg of morphine equivalents per day, have additional knowledge to prescribe methadone, recognize the risks of fentanyl patches, titrate cautiously, and reduce doses by at least 25% to 50% when switching opioids.
The guidelines also agree that opioid risk-assessment tools, written treatment agreements, and urine drug testing can mitigate risks.
The authors conclude that, despite limited evidence, recent guidelines on chronic pain agree on several opioid risk-mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug–drug and drug–disease interactions; and the use of risk-assessment tools, treatment agreements, and urine drug testing.