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 policies.
Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical
skills and knowledge in both the principles of opioid prescribing and on the assessment
and management of risks associated with opioid abuse, addiction, and diversion. Although
evidence is limited in many areas related to use of opioids for chronic noncancer
pain, this guideline provides recommendations developed by a multidisciplinary expert
panel after a systematic review of the evidence.