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Guidelines for Opioid Management of Pain

Guest Editorial from July/August 2006
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Editor's Note: One of the goals of the National Foundation for the Treatment of Pain, of which this author is Executive Director, is to improve the clinical care of pain patients. Dr. Hochman wrote an essay, "Essential Considerations in the Treatment of Chronic Pain" that was aimed at that objective. This article is intended to elaborate and expand upon the principles cited in that essay. A major issue in pain management concerns the “Standard of Care.” In some communities, opioids are still demonized as “addictive” and those who desperately need them as “drug-seekers.” In other communities, titration to effectiveness is standard, as in any pharmacotherapy. The objective of this article is to propose a standard approach to pain management, based upon rationality and evidence, as a Community Standard of Care—removed from mythology and politics.

The construction of these proposed guidelines has been a dynamic process. With over 100 physician-specialists involved in the process— through the “Project on Pain and Chemical Dependency”—many drafts and revisions have occurred. The following version has been accepted by all participants with the knowledge that changes may be made in the future, as thinking and analysis evolves. The “LIST,” as this ongoing process is known, was begun by Dr. Russell Portenoy more than 20 years ago and brings together physicians and others vitally concerned with pain management. The members of this project feel strongly that the proposed principles provides enormous advantages over previous efforts, as it puts emphasis on “defining what is right, not what is wrong.”

The guidelines provide clear and unambiguous guidance in the treatment of intractable pain. They establish the Standard of Care for practitioners very specifically, so that there can be no confusion or uncertainty about the proper and effective care of intractable pain patients. They clearly establish the goals of intractable pain treatment and objective means of measuring clinical needs and accomplishments. They eliminate the ambiguities that have created a devastating chill of physicians, causing them to cease treating pain patients out of anxiety and perceived vulnerability. At the same, they assist law enforcement by clearly delineating proper practices and promote rational and evidence-based medicine.

Proposed Opioid Guidelines

Last updated on: November 18, 2011
First published on: July 1, 2006