Chronic Pain Management Guidelines
It was the World Health Organization (WHO) that started the initiative to develop the chronic pain management guidelines as a response to the clamor from the experts and professional bodies that are dealing with the condition.
These chronic pain management guidelines and recommendations are based on the findings of the Delphi study and are intended to lead the way for health care professionals, policymakers and regulatory authorities as well as all medical practitioners, in general, in helping ensure the proper use of pain management medications and the effective and safe approach to pain control.
The overall objective of these chronic pain management guidelines is to provide evidence-based recommendations in the hope of improving the quality of life of adult and adolescent (i.e., people aged 11 – 18 years of age). Patients, with chronic but non-malignant pain like low back pain, arthritis or fibromyalgia all of which conditions are prevalent in 3 – 6 % of the world population. Not included under these chronic pain management guidelines are conditions pertaining to chronic pelvic pain, chronic post-surgical pain, phantom limb pain or multiple sclerosis. Adolescents are also covered under these chronic pain management guidelines because the pharmacology for them is similar to those for adults.
Under these chronic pain management guidelines, there must be a definition/reiteration of the concept of total pain as well as recommendations on the steps that must be taken in making an overall assessment and documentation of the pain that will include cause, severity, sleep disturbance, mood and social impact. The chronic pain management guidelines must also recognize the need to evaluate, measure and monitor pain and pain control across all settings. They must provide for frequently used and validated pain scales while at the same time recognizing the fact that many adult patients often do not report pain. Exacerbating this situation is the fact that many health workers frequently underestimate and/or undertreat the pain that their patients feel.
The chronic pain management guidelines also particularly address the use of opioids with questions such as:
• When to start giving opioids? When to try stopping or reducing them? When to try to introduce an alternative?
• How to cease giving opioids to patients who have been on escalating doses but for whom there has been a lack of effect at any dose?
• How to cease using opioids in people who have become tolerant to them and wish to cease using them or for whom the use has become problematic?
• How to rotate between opioids in an ambulatory and clinical setting?
• How to organize a drug holiday as a strategy to treat the tolerance phenomena since chronic pain and opioid dependence can overlap, resulting in specific management issues?
• How prescription of the opioids used in the management of chronic pain should minimize these problems?
• How to treat pain in patients who are opioid dependent?
• How to manage patients who have become dependent on their opioid medication and/or are abusing their prescription opioids?
These issues should be given serious considerations in promulgating chronic pain management guidelines as the use of opioids has become a chronic pain management approach, especially for those who are terminally ill.