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Chronic Pain Guidelines

In April 2010 a new list of  Chronic Pain Guidelines was published by The American Society of Anesthesiologists.

The new recommendations are designed to help clinicians who treat pain. The objectives are to optimize pain control, enhance physical and  psychological well-being, and minimize adverse outcomes.

The new guidelines appeared in the April issue of Anesthesiology. The recommendations apply to patients with chronic noncancer,
neuropathic, somatic, or visceral pain. The taskforce focused on interventional diagnostic procedures including diagnostic joint block, nerve block, and neuraxial opioid trials.

The key to chronic pain is creating an individualized treatment plan focused on optimizing the risk-to-benefit ratio. Treatment should progress from a lesser to greater degree of  invasiveness.

The new guidelines advocate for multimodal interventions for patients with chronic pain. The taskforce suggests that a long-term approach that includes periodic follow-up evaluations should be developed and implemented as part of the overall treatment strategy. In addition, when available, multidisciplinary programs may be used.

The new guidelines detail

* ablative techniques,
* acupuncture,
* blocks,
* botulinum toxin,
* electrical nerve stimulation,
* epidural steroids,
* intrathecal drug therapies,
* minimally invasive spinal procedures,
* pharmacologic management,
* physical therapy,
* psychological treatment, and
* trigger point injections.

Drugs for chronic pain include anticonvulsants, antidepressants, benzodiazepines, N-methyl-D-aspartate receptor antagonists,
nonsterioidal anti-inflammatories, opioid therapy, skeletal muscle relaxants, and topical agents. The taskforce discusses each in detail and recommends strategies for monitoring and managing adverse effects and patient compliance.

Anesthesiology. 2010;112:810-833.

Dr. Tucker comment: Over the years my practice has evolved to treating chronic pain patients. I work with my clients medical doctors to design personalized programs. My current approach to chronic pain is to use warm laser, physical therapy, breath and body awareness, gentle corrective exercises, natural topical agents, and nutritional therapy. The exercise rehabilitation approach I use is unique in that I blend several techniques to create a treatment plan that gives clients responsibility for participating in recovery. Clients particularly like the detailed nutritional information I provide.

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