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8 Articles in this Series
AAPM's Advice for Evidence-Based Opioid Prescribing Guidelines
CBT for Chronic Pain and Insomnia Needs More Research
Farewell Opioid Therapy, Hello Mental and Behavioral Health
Ketamine’s Growing Use in Chronic Non-Cancer Pain Management
MR Neurography in CRPS Assessment
Navigating New Opioid Prescribing Requirements: Practical Legal Advice for PCPs & Pain Specialists
TACs: Identifying and Treating the Non-Migrainous Headache
Video: Dr. Aronoff on Shifts in Pain Care

AAPM's Advice for Evidence-Based Opioid Prescribing Guidelines

A Q&A with AAPM's Steven P. Stanos, DO


The American Academy of Pain Medicine (AAPM) is holding its 34th Annual Meeting & in Vancouver this weekend (April 26-30), with a focus on Managing Acute & High-Impact Chronic Pain through Multidisciplinary Care. Prior to the conference opening, AAPM Immediate Past President Steven P. Stanos, DO, answered a few questions from Practical Pain Management regarding the organization’s support of the FDA’s recent announcement to develop evidence-based opioid prescribing guidelines. Dr. Stanos also serves as medical director of Swedish Pain Services and Occupational Medicine Services at Seattle’s Swedish Medical Center.


Will AAPM request specific funds or research into the effects of long-term opioid therapy?

AAPM would expect the FDA to call upon multiple stakeholders to participate in the development of guidelines for long-term opioid therapy. The academy would gladly be one of those stakeholders. Our core areas of expertise revolve around managing acute and chronic complex pain in our patients. But doing so successfully requires access to multiple approaches, including the use of medications, behavioral medicine, interventional care, and surgery to ensure that patients receive the right care for their individual needs. Funding for research is essential to understanding the effects of long-term opioid therapy in specific patient populations and to develop evidence-based prescribing guidelines. Sources of this funding should include the federal government, pharmaceutical companies, and other stakeholders.


What types of changes does AAPM envision in drug labeling?

AAPM has not historically been involved in decisions about drug labeling as that is the purview of the FDA, but the academy would likely support clear and easily understood labeling practices that provide the patient with relevant information about possible reactions to medications and novel approaches to packaging that may help to ensure safe use and disposal of medications. AAPM has submitted evidence-based comments and presented those recommendations via the standard FDA processes . We look forward to continuing to provide input.


Will the prevention of pain chronification be a priority, with regard to perioperative pain management, especially post-surgical prescribing?

Over the past 30 years, so much has been learned about how pain progresses from an acute to chronic state including complex pathophysiologic and psychosocial changes. These patient-specific changes contribute to the challenges pain management providers face in predicting, assessing, and treating patients suffering from high impact persistent pain. More aggressive multimodal perioperative pain management may help to reduce the prevalence or severity of chronic pain. The academy supports the evolution of acute and perioperative pain interventions and best practices. To this end, the academy is writing a textbook on case-based acute pain medicine, which we anticipate publishing in 2019. Additionally, AAPM is preparing a consensus document for Enhanced Recovery After Spine Surgery (ERAS), which we anticipate publishing before year’s end.


Does AAPM see time-limited opioid medications as the wave of future prescribing, and/or biopharmaceutical development?

The academy supports efforts, including professional education and development of safer medications, to reduce risk of overdose, diversion, or addiction. In principle, limiting the duration and dosage of prescribing is encouraged. However, AAPM does not support arbitrary maximum dosages or durations for prescriptions:  Due to variability in patient’s response to treatment, the decision around dose and duration should be a decision made between the physician and the patient, not legislated, or determined by other parties.


Will AAPM tackle the former CDC guidelines on opioid prescribing in terms of offering suggested amendments with regard to short/long-term opioid therapy, or to opioid naïve versus opioid legacy patients with chronic pain disease? 

The academy has engaged a diverse panel of experts, comprised both of AAPM members and other stakeholders, bringing a range of perspectives to review the evidence that underlies the CDC Guideline for Prescribing Opioids for Chronic Pain and to draft a consensus statement interpreting the guideline for practical implementation in clinical practice. We expect that this paper will be submitted for publication to a peer-reviewed journal later this year.


Would AAPM agree that naloxone may need to become equivalent to the public’s knowledge/use of EpiPens, for example, and the importance of being prepared in case of emergency?

AAPM supports the use of naloxone and believes that those likely to use the drug should be made aware of its safety and usefulness via public education. Additionally, physicians should be encouraged to consider co-prescribing naloxone when prescribing opioids in high-risk patients, including those with chronic obstructive pulmonary disease (COPD) and sleep apnea situations, those on higher dose therapy, those with opioid and other sedative combination therapy, and those with a history of comorbid psychiatric disorders, including substance use disorder. The academy is supportive of the efforts of the FDA to maximize the availability of this drug that could be life-saving.


Unable to attend the AAPM meeting in person? Look for PPM’s highlights coverage over the following week and on Twitter@PracticalPain.


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