April 1, 2010 — For the first time in more than a decade, an American Society of Anesthesiologists taskforce has updated its chronic pain guidelines.
The new recommendations are designed to help clinicians who treat pain. The objectives are to optimize pain control, enhance physical and psychological well-being, and minimize adverse outcomes.
Richard Rosenquist, MD, from the University of Iowa Hospital, Iowa City, led the 12-member taskforce of anesthesiologists in both private and academic practice from various parts of the United States. The group also worked with members of the American Society of Regional Anesthesia and Pain Medicine.
The new guidelines appear in the April issue of Anesthesiology.
The recommendations apply to patients with chronic noncancer, neuropathic, somatic, or visceral pain. The taskforce focused on interventional diagnostic procedures including diagnostic joint block, nerve block, and neuraxial opioid trials.
Focus on Interventional Diagnostic Procedures
The team agreed that findings from the patient history, physical examination, and diagnostic evaluation should be combined to provide an individualized treatment plan focused on optimizing the risk-to-benefit ratio. Treatment should progress from a lesser to greater degree of invasiveness.
"Whenever possible," the taskforce reports, "direct and ongoing contact should be made and maintained with the other physicians caring for the patient to ensure optimal care."
The new guidelines advocate for multimodal interventions for patients with chronic pain. The taskforce suggests that a long-term approach that includes periodic follow-up evaluations should be developed and implemented as part of the overall treatment strategy. In addition, when available, multidisciplinary programs may be used.
The new guidelines detail
ablative techniques,
acupuncture,
blocks,
botulinum toxin,
electrical nerve stimulation,
epidural steroids,
intrathecal drug therapies,
minimally invasive spinal procedures,
pharmacologic management,
physical therapy,
psychological treatment, and
trigger point injections.
The taskforce defines chronic pain as pain of any etiology not directly related to neoplastic involvement associated with a medical condition or extending in duration beyond the expected temporal boundary of tissue injury and normal healing and adversely affecting the function or well-being of the individual.
Drugs for chronic pain include anticonvulsants, antidepressants, benzodiazepines, N-methyl-D-aspartate receptor antagonists, nonsterioidal anti-inflammatories, opioid therapy, skeletal muscle relaxants, and topical agents. The taskforce discusses each in detail and recommends strategies for monitoring and managing adverse effects and patient compliance.
The new guidelines cover a range of advances not included in the initial version published in 1997. As a result, the number of pages has more than doubled in the new publication. The complete guidelines are available online.
Financial disclosures for the 12 members of the American Society of Anesthesiologists taskforce were not provided.
