Choosing Wisely:

Don’t prescribe opioid analgesics as first-line therapy to treat chronic non-cancer pain.

Rationale and Comments: Physicians should consider multimodal therapy, including non-drug treatments such as behavioral and physical therapies prior to pharmacological intervention. If drug therapy appears indicated, non-opioid medication (e.g., nonsteroidal anti-inflammatory drugs, anticonvulsants) should be trialed prior to commencing opioids.
Sponsoring Organizations:
  • American Society of Anesthesiologists
  • Sources:
  • American Society of Anesthesiologists guidelines
  • Disciplines:
  • Neurologic
  • References: • Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O’Connor PG, Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH, Miaskowski C. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain [Internet]. J Pain. 2009 Feb [cited 2014 Jan 10];10(2):113–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19187889
    • American Society of Anesthesiologists Task Force on Chronic Pain Management, American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010 Apr;112(4):810–33.
    • Argoff CE, Albrecht P, Irving G, Rice F. Multimodal analgesia for chronic pain: rationale and future directions. Pain Med. 2009;10(S2):S53–66.

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