|
Prescripción responsable, segura y efectiva de opiáceos para el dolor crónico no relacionado con el cáncer: guías de la American Society of Interventional Pain Physicians (ASIPP).
Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines.
Manchikanti L, Kaye AM, Knezevic NN1, McAnally H2, Slavin K3, Trescot AM4, Blank S5, Pampati V, Abdi S6, Grider JS, Kaye AD, Manchikanti KN7, Cordner H, Gharibo CG, Harned ME, Albers SL, Atluri S, Aydin SM8, Bakshi S, Barkin RL, Benyamin RM, Boswell MV9, Buenaventura RM, Calodney AK, Cedeno DL10, Datta S, Deer TR, Fellows B, Galan V11, Grami V, Hansen H, Helm Ii S, Justiz R, Koyyalagunta D, Malla Y, Navani A12, Nouri KH, Pasupuleti R, Sehgal N, Silverman SM, Simopoulos TT13, Singh V14, Solanki DR15, Staats PS16, Vallejo R, Wargo BW, Watanabe A17, Hirsch JA1
CONCLUSIONS: These guidelines were developed based on comprehensive review of the literature, consensus among the panelists, in consonance with patient preferences, shared decision-making, and practice patterns with limited evidence, based on randomized controlled trials (RCTs) to improve pain and function in chronic non-cancer pain on a long-term basis. Consequently, chronic opioid therapy should be provided only to patients with proven medical necessity and stability with improvement in pain and function, independently or in conjunction with other modalities of treatments in low doses with appropriate adherence monitoring and understanding of adverse events.Key words: Chronic pain, persistent pain, non-cancer pain, controlled substances, substance abuse, prescription drug abuse, dependency, opioids, prescription monitoring, drug testing, adherence monitoring, diversionDisclaimer: The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care."
|
Guías de los CDC para la prescripción de opiáceos para el dolor crónico - Estados Unidos, 2016.
CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.
JAMA. 2016 Apr 19;315(15):1624-45. doi: 10.1001/jama.2016.1464.
Abstract
IMPORTANCE:Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE: To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS: The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioidsand conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category. EVIDENCE SYNTHESIS: Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects. RECOMMENDATIONS: There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. CONCLUSIONS AND RELEVANCE: The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
|
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
|
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
|
|
|
|  |
|
