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Practice Guidelines for Chronic Pain Management

2010; Lippincott Williams & Wilkins; Volume: 112; Issue: 4 Linguagem: Inglês

10.1097/aln.0b013e3181c43103

1528-1175

Clinical practice guidelines implementation

P RACTICE Guidelines are systematically developed recom- mendations that assist the practitioner and patient in making decisions about health care.These recommendations may be adopted, modified, or rejected according to clinical needs and constraints and are not intended to replace local institutional policies.In addition, Practice Guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.Practice Guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice.They provide basic recommendations that are supported by synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.This document updates the "Practice Guidelines for Chronic Pain Management," adopted by the ASA in 1996 and published in 1997. 1 Methodology A. Definition of Chronic PainFor these Guidelines, chronic pain is defined as pain of any etiology not directly related to neoplastic involvement, associated with a chronic 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. B. Purposes of the GuidelinesThe purposes of these Guidelines are to (1) optimize pain control, recognizing that a pain-free state may not be attainable; (2) enhance functional abilities and physical and psychologic well-being; (3) enhance the quality of life of patients; and (4) minimize adverse outcomes. C. FocusThese Guidelines focus on the knowledge base, skills, and range of interventions that are the essential elements of effective management of chronic pain and pain-related problems.The Guidelines recognize that the management of chronic pain occurs within the broader context of health care, including psychosocial function and quality of life.These Guidelines apply to patients with chronic noncancer neuropathic, somatic (e.g., myofascial), or visceral pain syndromes.The Guidelines do not apply to patients with acute pain from an injury or postoperative recovery, cancer pain, degenerative major joint disease pain, headache syndromes (e.g., migraine and cluster), temporomandibular joint syndrome, or trigeminal or other neuralgias of the head or face.In addition, the Guidelines do not apply to pediatric patients and do not address the administration of intravenous drugs or surgical interventions other than implanted intrathecal drug delivery systems and nerve stimulators.