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Pain Treatment Guidelines - Descriptions

The following guidelines are organized by year of publication (descending order) within logical clinical categories. The 'sunset' period for retiring documents is 5-years; see 'outdated' section for older, retired guidelines of importance.

NOTE: All URL links were active as of the dates accessed. However, the Internet is constantly changing and some linked resources may move or become inactive with time. To notify us of invalid links, send e-mail to: Info@Pain-Topics.org.

Current Pain Treatment Guidelines

• General Pain & Safety Topics
• Acute Pain
• Cancer Pain
• Cardiac & Chest Pain
• Chronic & Intractable Pain
• Geriatric Pain
• Gynecological or Obstetrical Pain
• Headache
• Musculoskeletal Pain (including Arthritis and Fibromyalgia)
• Neuropathic Pain
• Non-Opioid & Complementary Therapies
• Opioid Therapy & Safety
• Pain in Palliative Care
• Pediatric Pain
• Perioperative Pain

Outdated Pain Treatment Guidelines of Importance <Click Here>

General Pain & Safety Topics

ACR Criteria for Diagnostic Imaging in Pain Conditions

Access: http://acsearch.acr.org/
Source: American College of Radiology (ACR)
Date: 2005-2007
Description: The ACR has developed evidence-based guidelines for use in a wide range of imaging decisions in patients presenting with pain. Each guideline is developed by a panel of experts in the field and reviewed by the ACR Committee on Appropriateness Criteria. The guideline for each condition lists several variants (e.g. symptoms, patient age, etc.) and rates the appropriateness of each relevant radiologic procedure. A summary of the literature regarding evidence for diagnostic effectiveness follows each set of procedure recommendations. A search for topics by condition or procedure can be performed at the URL address listed above, or you can access individual pain topic guidelines below:

Nontraumatic knee pain; Access PDF…>

Acute abdominal pain and fever or suspected abdominal abscess; Access PDF…>

Acute onset flank pain, suspicion of stone disease; Access PDF…>

Right lower quadrant pain; Access PDF…>

Right upper quadrant pain; Access PDF…>

Left lower quadrant pain; Access PDF…>

Acute onset of scrotal pain (without trauma, without antecedent mass); Access PDF…>

Acute chest pain – suspected myocardial ischemia; Access PDF…>

Acute chest pain – suspected aortic dissection; Access PDF…>

Acute chest pain – no ECG or enzyme evidence of myocardial ischemia/infarction; Access PDF…>

Low back pain; Access PDF…>

Chronic foot pain; Access PDF…>

Chronic wrist pain; Access PDF…>

Chronic ankle pain; Access PDF…>

Chronic elbow pain; Access PDF...>

Chronic neck pain; Access PDF...>

Headache; Access PDF...>

Headache—Child; Access PDF...

Access for all links checked April 25, 2008.

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association

Access: http://www.circ.ahajournals.org/cgi/reprint/115/12/1634
Source: American Heart Association (AHA)
Date: 2007
Print Reference: Antman EM, Bennett JS, Daugherty A, et al. Use of nonsteroidal antiinflammatory drugs. An update for clinicians. A scientific statement from the American Heart Association. Circulation. 2007(Mar);115(12):1634-1642.
Description: These guidelines were developed to update clinicians on the AHA recommendations for the selection of nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with existing cardiovascular disease or risk. Growing evidence demonstrating an increased risk of cardiovascular events with the use of NSAIDs has led to confusion about the selection of analgesic medications for pain relief. This scientific statement summarizes the trials that reported cardiovascular events in patients who took analgesic drugs that inhibit COX enzymes. The recommendations for pain management include a stepped approach beginning with nonpharmacologic interventions and continuing with appropriate drug therapy that is based on an individual risk-benefit analysis for each patient. 9 Pages. Access checked April 25, 2008.

Guidelines on Pain Management

Access: http://www.uroweb.org/fileadmin/user_upload/Guidelines/pain.pdf
Source: European Association of Urology
Date: 2003
Description: This guideline begins with a discussion of the physiology of pain as it relates to the urogenital system. Pain assessment and analgesic selection, including opioid therapy, are examined. The discussion of opioids includes dosing, routes of administration and the management of adverse effects. Pain management in urogenital cancers and chronic pelvic pain are covered in detail. 58 Pages. Access checked April 25, 2008.

Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult

Access: http://www.sccm.org/pdf/sedatives.pdf
Source: Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists (ASHP), American College of Chest Physicians
Date: 2002 (Originally published in 1995)
Print Reference: Jacobi J, Fraser GL, Coursin DB, Riker RR, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002 Jan;30(1):119-41.
Description: The challenges of assessing and treating patients under prolonged sedation and analgesia are unique in the patient requiring mechanical ventilation. Assessment methods and measurement scales for sedation and agitation are discussed; an algorithm and specific recommendations for drug selection are included. 23 Pages. Access checked April 25, 2008.

Nursing Best Practice Guideline: Assessment and Management of Pain

Access: http://www.rnao.org/bestpractices/PDF/BPG_Assessment_of_Pain.pdf
Source: Registered Nurses Association of Ontario
Date: 2002
Description: Recommendations for best nursing practices are presented as evidence-based guidelines for registered nurses and registered practical nurses. Seventy-nine recommendations are made for assessment (including documentation), healthcare organization policies, and pharmacological treatment. An appendix includes assessment tools, an analgesic ladder, sample subcutaneous injection protocol, and non-pharmacological interventions. 147 Pages. Access checked April 25, 2008.

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Acute Pain

Assessment and Management of Acute Pain

Access: http://www.icsi.org/pain_acute/pain__acute__assessment_and_management_of__3.html
  NOTE: Adobe Reader Ver 7.0 or higher is required to access this file.
Source: Institute for Clinical Systems Improvement (ICSI)
Date: 2008

Description: Acute pain strikes all ages and this evidence-based guideline has been developed for all, from infants to the elderly. An assessment algorithm aids in the evaluation of somatic, visceral, and neuropathic pain symptoms; a second algorithm includes specific treatment options for different types and causes of pain. The 3 mechanisms of pain are considered individually and in combination; great emphasis is placed on thorough assessment, including assessment tools for children and adults. To learn more about ICSI or to order a printed copy ($10), visit www.icsi.org. 59 Pages. Access checked June 23, 2008.

APS 2005 Recommendations for Improving the Quality of Acute and Cancer Pain Management

Access: http://www.ampainsoc.org/pub/bulletin/fal05/inno1.htm
Source: American Pain Society
Date: 2005 (Revision and expansion of the 1995 Quality Improvement Guidelines)
Print Reference: Gordon DB, Dahl JL, Miaskowski C, et al. American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Internal Med. 2005(Jul);165(14):1574-1580.
Description: Based on expert consensus and a systematic review of the literature on quality improvement in pain management, recommendations were made to improve the quality of pain management in all care settings. Recent knowledge in pain management led to the design and testing of new ways for communication and treatment continuity across care environments. Quality improvement recommendations are available at no charge by calling APS at (847) 375-4715 or writing info@ampainsoc.org. 7 Pages. Access checked April 25, 2008.

Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 5th Edition

Access: http://www.ampainsoc.org/pub/principles.htm
Source: American Pain Society
Date: 2003 (Originally published in 1999)
Description: This easy-to-use guide offers concise dosing tables and a revised opioid relative potency table that includes data from recent repeated-dose studies. The revisions also cover recent information on opioids and the role of metabolites in the pharmacologic response as well as a new section on local anesthetics. 73 Pages. Access checked September 26, 2006.

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Cancer Pain

Adult Cancer Pain

Access: http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf
Source: National Comprehensive Cancer Network (NCCN)
Date: 2007
Description: This NCCN guideline is presented in a concise, easy-to-use format that includes algorithms for assessment, follow-up, and interventional therapy referral decisions. Prescribing and titration tables for opioids, non-opioid dosing, and a guide for the management of opioid adverse effects are all summarized in an at-a-glance format. Additionally, guidance is offered for specific pain challenges, specialty referrals for complementary therapy, and patient education. 31 pages. Access checked April 28, 2008.

Guideline for the Management of Cancer Pain in Adults and Children

Access: http://www.ampainsoc.org/pub/cancer.htm
Source: American Pain Society
Date: 2005
Description: An evidence-based clinical practice guideline that is designed to help clinicians and patients improve control of the pain associated with cancer. It describes recent discoveries in the causes of pain, assessment techniques, and therapeutic strategies to manage cancer pain. Available for purchase only through the website (click on the APS Online Store); members $15, non-members $20. 166 Pages. Access checked April 25, 2008.

Intrathecal Drug Delivery for the Management of Cancer Pain: A Multidisciplinary Consensus of Best Clinical Practices

Access: http://www.supportiveoncology.net/journal/articles/0306399.pdf
Source: Multidisciplinary workshop; unrestricted grant to Valley Cancer Pain Foundation
Date: 2005
Print Reference: Stearns L, Boortz-Marx R, DuPen S,et al. Intrathecal drug delivery for the management of cancer pain. A multidisciplinary consensus of best clinical practices. J Support Oncol. 2005(Nov-Dec);3(6):399-408.
Description: The management of cancer pain often requires an interdisciplinary approach, and intrathecal delivery is a rapid method of treating intractable pain that can be used concurrently during radiology treatment or a chemotherapy regimen. It can provide effective pain management for patients who cannot tolerate oral medications, those with complex pain syndromes or opioid intolerance concerns. The guidelines include dosing and titration recommendations and algorithms for short-term and long-term cancer survivors. 10 Pages. Access checked April 25, 2008.

Cancer Pain

Access: http://utm-ext01a.mdacc.tmc.edu/mda/cm/CWTGuide.nsf/LuHTML/SideBar1?OpenDocument
Source: The University of Texas MD Anderson Cancer Center
Date: 2003
Description: Using a 1-10 intensity scale, the level of pain algorithm guides the clinician to recommendations for pharmacologic treatment. Other tools include an opioid conversion table as well as dosing guidelines for fentanyl, methadone, and oral transmucosal fentanyl citrate. 7 Pages. When page is accessed via link above, click on "Symptom Control & Palliative Pain” in left column. Access checked April 25, 2008.

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Cardiac & Chest Pain

Management of Cocaine-Associated Chest Pain and Myocardial Infarction. A Scientific Statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology

Access: http://circ.ahajournals.org/cgi/reprint/117/14/1897
Source: American Heart Association (AHA)
Date: 2008
Print Reference: McCord J, Jneid H, Hollander JE, et al. Circulation. 2008(Apr 8);117(14):1897-1907.
Description: Symptoms of cocaine use can mimic those of myocardial infarction (MI) and 2 treatments typically used to treat an MI can be dangerous to cocaine users. Following a critical analysis of existing literature, the AHA developed recommendations for diagnostic evaluation and treatment by levels-of-evidence. The guidelines recommend early identification of cocaine use by self-report or by laboratory testing. While research showed that only 1% to 6% of patients with cocaine-associated chest pain actually had an MI, there are several important reasons for early identification of cocaine use. Access checked April 28, 2008.

Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome

Access: http://www.icsi.org/acs_acute_coronary_syndrome/acute_coronary_syndrome...
  NOTE: Adobe Reader Ver 7.0 or higher is required to access this file.
Source: Institute for Clinical Systems Improvement (ICSI)
Date: 2006
Description: Timely treatment is crucial to the success of emergency intervention for patients with high-risk chest pain. Seven clinical algorithms are presented: chest pain screening, emergency intervention, ST-segment elevation myocardial infarction (STEMI), acute myocardial infarction (AMI), AMI complications, special work-up for chest pain unrelated to coronary artery disease, non-cardiac causes, and clinic evaluation. 77 Pages. Access checked April 25, 2008.

Pain Management in Blunt Thoracic Trauma: An Evidence-Based Outcome Evaluation

Access: http://www.east.org/tpg/painchest.pdf
Source: Eastern Association for the Surgery of Trauma
Date: 2003
Description: These recommendations are the result of a review and grading of 91 studies of rib fractures, chest wounds, and thoracic injuries. Various modalities of analgesic management are evaluated and recommendations are made based on efficacy and technical considerations. 79 Pages. Access checked April 25, 2008.

ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina

Access: http://www.acc.org/qualityandscience/clinical/guidelines/stable/stable_clean.pdf
Source: American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Date: 2002 (Originally published in 1999)
Description: The most common manifestation of ischemic heart disease is chronic stable angina. Considering the high rates of morbidity and mortality, the aim of the ACC/AHA Task Force was to improve patient outcomes and use the most effective strategies to reduce the overall cost of care. These guidelines use the 3 ACC/AHA classes for the recommendations presented in 4 sections: diagnosis, risk stratification, treatment, and patient follow-up. Three algorithms for management are presented: clinical assessment, stress testing/angiography, and treatment. A treatment mnemonic highlights the 10 treatment components that the Task Force identified as most important. 125 Pages. Access checked April 25, 2008.

ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction

Access: http://www.acc.org/qualityandscience/clinical/guidelines/unstable/update_index.htm
Source: American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Date: 2002 (Originally published in 2000)
Description: These guidelines focus on 2 components of acute coronary syndrome which is a life-threatening disorder frequently requiring emergency medical care. Pathophysiology, presentation, assessment, and risk stratification are examined in the first two sections; hospital care, coronary revascularization, and the management of special populations are covered in the last 4 sections. These guidelines use the 3 ACC/AHA classes for the recommendations presented in each section. 93 Pages. Access checked April 25, 2008.

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Chronic & Intractable Pain

Assessment and Management of Chronic Pain

Access: http://www.icsi.org/pain__chronic__assessment_and_management_of_14399/...
  NOTE: Adobe Reader Ver 7.0 or higher is required to access this file.
Source: Institute for Clinical Systems Improvement (ICSI)
Date: 2007
Description: This ICSI guideline aims to improve the effectiveness of chronic pain treatment and resulting physical functionality by using a biopsychosocial model and a multi-specialty team approach. Assessment and management algorithms are presented; patient questionnaires, agreements, and a pain inventory are also included. To learn more about ICSI or to order a printed copy ($10), visit www.icsi.org. 88 Pages. Access checked April 25, 2008.

Complex Regional Pain Syndrome: Treatment Guidelines

Access: http://www.rsds.org/3/clinical_guidelines/index.html#diagnosis
Source: Reflex Sympathetic Dystrophy Syndrome Association
Date: 2006
Description: Complex Regional Pain Syndrome (CRPS), formerly called Reflex Sympathetic Dystropy, is challenging to diagnose and treat. This guideline presents a history of the challenges involved in the validation of existing diagnostic criteria and summarizes two separate sets of criteria for use in clinical and research applications. An interdisciplinary approach to restoring the patient’s functionality by managing pain, edema and other symptoms is discussed. Treatment algorithms and recommendations for an evidence-based approach to pharmacology and interventional therapy are presented; physical therapy and psychotherapy are examined as crucial components of the overall treatment program. 68 Pages. Access checked April 25, 2008.

Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome Clinical Practice Guidelines, 3rd Edition

Access: http://rsdfoundation.org/en/en_clinical_practice_guidelines.html
Source: International Research Foundation for RSD/CRPS
Date: 2003 (Updated January 25, 2006)
Description: Reflex Sympathetic Dystrophy Syndrome (RSD), also known as Complex Regional Pain Syndrome (CRPS), is a multi-symptom, multi-system, syndrome usually affecting one or more extremities, and continues to be poorly understood. This guideline covers the clinical features of RSD/CRPS and important diagnostic strategies. A comprehensive treatment protocol is defined and video presentations on sympathetic lumbar nerve block techniques are included. 26 Pages. Access checked April 25, 2008.

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Geriatric Pain

Clinical Practice Guideline: Pain Management in the Long Term Care Setting

Access: http://www.amda.com/tools/cpg/chronicpain.cfm
Source: American Medical Directors Association
Date: 2003 (Originally published in 1999)
Description: This guideline examines barriers to effective pain management as well as acute pain management in response to the Centers for Medicare & Medicaid Services (CMS) quality initiative measure for pain. The challenges of recognizing pain in the cognitively impaired, pain management in palliative care, and alternative therapies are also described. Available for purchase only; members $20, non-members $30. 31 Pages. Access checked April 25, 2008.

The AGS Guideline on the Management of Persistent Pain in Older Persons

Access: http://www.americangeriatrics.org/products/positionpapers/persistent_pain_guide.shtml
Source: American Geriatrics Society (AGS), Panel on Persistent Pain in Older Persons
Date: 2002
Print Reference: AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002. Jun;50(6)Suppl:S205-24.
Description: The goal of the AGS is to provide an overview of the principles of pain management as they apply to the geriatric patient. Specific recommendations are made for interdisciplinary assessment as well as pain assessment tools for the cognitively impaired. Existing literature and the consensus of the panel of experts is synthesized into recommendations for pharmacologic pain management and non-pharmacologic therapy. 20 Pages. Access checked April 25, 2008.

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Gynecological or Obstetrical Pain

European Guidelines for the Diagnosis and Treatment of Pelvic Girdle Pain

Access: http://www.backpaineurope.org/web/files/586_2008_602_OnlinePDF.pdf
Source: Working Group 4 of the European Commission Research Directorate General
Date: 2008
Print Reference: Vleeming A, Albert HB, Ostgaard HC, et al. European Spine Journal. 2008(Feb 8); Early online publication prior to print.
Description: This guideline was developed following an evaluation of evidence-based literature and the creation of a grading system for recommendations on the diagnosis and treatment of patients with pelvic girdle pain (PGP). Working Group 4 concluded that PGP is a form of low back pain that can occur with or without low back pain. Factors that influence and those that appear not to influence risk are listed and explained. Treatment recommendations include medication use for nonpregnant women, education and reassurance, individualized exercises, and multidisciplined therapy. Access checked April 28, 2008.

Practice Guidelines for Obstetric Anesthesia. An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.

Access: http://www.asahq.org/publicationsAndServices/OBguide.pdf
Source: American Society of Anesthesiologists (ASA)
Date: 2006
Print Reference: Practice Guidelines for Obstetric Anesthesia. An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. 2007(Apr);106(4):843-863.
Description: The ASA Task Force reviewed evidence-based literature and invited the opinions of a panel of consultants and practitioners to develop an update to guidelines that were originally adopted in 1998. The update provides expanded recommendations for pain management during labor, operative and non-operative deliveries, and the postpartum period. The revised guidelines include the recommendation that the level of care and equipment available to patients in the main operating room also be provided to all obstetric patients. Each recommendation is supported by a strength-of-evidence evaluation and the appendix to the guideline includes a meta-analysis summary. Text version: 52 Pages. Access checked April 25, 2008.

Consensus Guidelines for the Management of Chronic Pelvic Pain - Part One and Part Two

Access: Part One: http://www.sogc.org/guidelines/public/164E-CPG1-August2005.pdft
Access: Part Two: http://www.sogc.org/guidelines/public/164E-CPG2-September2005.pdf
Source: Chronic Pelvic Pain Working Group, Society of Obstetricians and Gynaecologists of Canada
Date: 2005
Print Reference: Part One: Jarrell JF, Vilos GA, Abu-Rafea B, et al. Chronic Pelvic Pain Committee. Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can. 2005(Aug);27(8):781-826.
Print Reference: Part Two: Jarrell JF, Vilos GA, Abu-Rafea B, et al. Chronic Pelvic Pain Committee. Consensus guidelines for the management of chronic pelvic pain. J Obstet Gynaecol Can. 2005(Sep);27(9):869-887.
Description: Part one contains 6 chapters which address individual aspects of chronic pelvic pain. Physiology, etiology, assessment, and laparoscopic investigations are examined in the first 4 chapters; specific gynecological, urological and gastrointestinal conditions are explored in chapters 5 and 6 (21 Pages). Part two contains 8 chapters covering myofascial dysfunction plus recommendations for medical, surgical and complementary/alternative interventions for the management of chronic pelvic pain (19 Pages). Access checked April 25, 2008.

The Initial Management of Chronic Pelvic Pain

Access: http://www.rcog.org.uk/resources/Public/pdf/initial_%20management_chronic_pelvic_pain41.pdf
Source: Royal College of Obstetricians and Gynaecologists
Date: 2005
Description: Because chronic pelvic pain is a symptom, not a diagnosis, this guideline stresses the importance of a comprehensive history and assessment that include psychological and social considerations. Diagnostic imaging and laparoscopy are recommended according to levels of evidence. A flowchart summarizes management and referral of chronic pelvic pain patients. 12 Pages. Access checked April 25, 2008.

Cyclic Perimenstrual Pain and Discomfort: Nursing Management. Evidence-Based Clinical Practice Guideline

Access: http://www.guideline.gov/summary
Source: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
Date: 2003
Description: This evidence-based clinical practice guideline is designed to assist nurses in patient assessment strategies that includes identifying pain relief obtained from current interventions as well as current treatment adherence patterns. In addition to an evaluation of symptom and relief patterns, the nursing interventions include mutual goal-setting with the patient and multimodal treatment strategies. A print copy of the 48-page book is available for purchase through the website: http://www.awhonn.org (click on the AWHONN Online Store/Evidence Based Guidelines); members $30, non-members $45. The National Guideline Clearinghouse link provided above offers a 10-page summary of the guideline. Access checked April 25, 2008.

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Headache

Diagnosis and Treatment of Headache

Access: http://www.icsi.org/headache/headache__diagnosis_and_treatment_of_2609.html
  NOTE: Adobe Reader Ver 7.0 or higher is required to access this file.
Source: Institute for Clinical Systems Improvement (ICSI)
Date: 2007
Description: This guideline emphasizes appropriate assessment and provides a thorough analytical framework that includes 10 algorithms for the diagnosis and treatment of headache. A drug table with a discussion of treatment considerations for the female population is provided. The authors include a presentation of the warning signs of potential disorders other than primary headache. To learn more about ICSI or to order a printed copy ($10), visit www.icsi.org. 73 Pages. Access checked June 20, 2007.

EFNS Guideline on the Drug Treatment of Migraine – Report of an EFNS Task Force

Access: http://www.efns.org/files/guideline_37.pdf
Source: European Federation of Neurological Societies
Date: 2006
Print Reference: Evers S, Afra J, Frese A, et al. EFNS guidelines on the drug treatment of migraine—report of an EFNS task force. Eur J Neurol. 2006(Jun);13(6):560-572.  
Description: This guideline for the management of migraine was created as an evidence-based aid to for the reduction of moderate to severe pain that can inflict significant disability on the migraineur. Pharmacotherapy recommendations for the treatment of acute attacks and prophylactic management are provided on the basis of the levels of evidence for efficacy. A section on triptans compares the individual drugs for their time to onset, efficacy and side effects. 13 Pages. Access checked April 25, 2008.

EFNS Guidelines on the Treatment of Cluster Headache and Other Trigeminal-Autonomic Cephalalgias

Access:http://www.efns.org/files/guideline_49.pdf
Source: European Federation of Neurological Societies
Date: 2006
Print Reference: May A, Leone M, Afra J, et al. EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias. 2006(Oct);13(10):1066-1077.  
Description: This guideline begins with a description of each headache disorder using the International Headache Society’s diagnostic criteria. Cluster headache, paroxysmal hemicrania, and SUNCT syndrome are addressed individually. Following an extensive literature review and expert consensus, three grades of evidence-based recommendations for the treatment of these specific headache disorders are made; practice pointers for dosing and length of treatment are included. Guidelines are provided for prophylactic therapy as well as for the treatment of the acute cluster headache attack. 12 Pages. Access checked April 25, 2008.

The International Classification of Headache Disorders, 2nd Edition

Access: headacheclassification Web-based edition (2008) at: http://ihs-classification.org/en/
Source: International Headache Society (IHS)
Date: 2004
Print Reference: Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, Second Edition. Cephalalgia. 2004(May);24(Suppl. 1):8-160.
Description: This new edition -- and the more recent web-based edition (recommended) -- replaces the original International Classification of Headache Disorders published in 1988 and was developed for research and clinical practice alike. Many sources of evidence were used to update the classification, including epidemiological studies and longitudinal studies that focused on diagnostic and treatment results. Additions to this version include a new classification for ‘Chronic Migraine’, as well as a chapter that looks at the small field of research on headaches that can be attributed to psychiatric disorders. 150 Pages. Access checked August 1, 2008.

2006 Report: New Appendix Criteria Open for a Broader Concept of Chronic Migraine. Following the release of the 2004 revised classification above, the Headache Classification Committee of the IHS expanded the ‘Chronic Migraine’ category in response to additional clinical evidence that the existing category included very few patients. In addition, the ‘Medication Overuse Headache’ category has been redefined. The abstract is available at: http://dx.doi.org/10.1111/j.1468-2982.2006.01172.x Access checked August 1, 2008.
Print Reference: Headache Classification Committee of the International Headache Society. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006(Jun);26(6):742-746.

Treatment of Primary Headache: Acute Migraine Treatment. Standards of Care for Headache Diagnosis and Treatment

Access:
http://www.guideline.gov/summary/summary.aspx?doc_id=6579&nbr=004139&string=guidelines+
AND+pain
Source: National Headache Foundation (NHF)
Date: 2004
Print Reference: Ward MN. Treatment of primary headache: chronic daily headache. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. p. 73-80.
Description: Four diagnostic categories and the primary types and secondary causes of chronic daily headache are described. The importance of patient education and involvement in the treatment plan for chronic headache is discussed. Drugs used for acute treatment should be selected with the aim of reducing the risk of complicating the chronic treatment regimen. A print copy of the 122-page book, Standards of Care for Headache Diagnosis and Treatment is available for $12 from the NHF by calling 888-NHF-5552. The link above provides an abbreviated version from the National Guideline Clearinghouse. 8 Pages. Access checked April 25, 2008.

Treatment of Primary Headache: Chronic Daily Headache. Standards of Care for Headache Diagnosis and Treatment

Access:
http://www.guideline.gov/summary/summary.aspx?doc_id=6583&nbr=004143&string=acute+AND
+migraine+AND+treatment
Source: National Headache Foundation (NHF)
Date: 2004
Print Reference: Ward MN. Treatment of primary headache: chronic daily headache. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. p. 73-80.
Description: Four diagnostic categories and the primary types and secondary causes of chronic daily headache are described. The importance of patient education and involvement in the treatment plan for chronic headache is discussed. Drugs used for acute treatment should be selected with the aim of reducing the risk of complicating the chronic treatment regimen. A print copy of the 122-page book, Standards of Care for Headache Diagnosis and Treatment is available for $12 from the NHF by calling 888-NHF-5552. The link above provides an abbreviated version from the National Guideline Clearinghouse. 8 Pages. Access checked April 25, 2008.

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Musculoskeletal Pain (including Arthritis and Fibromyalgia)

American College of Rheumatology 2008 Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis

Access: http://www.rheumatology.org/publications/guidelines/recommendations.pdf
Source: American College of Rheumatology
Date: 2008
Print Reference: Saag KG, Teng GG, Patkar NM, et al. Arthritis & Rheumatism. 2008(Jun 15);59(6):762-784.
Description: These evidence-based guidelines begin with an explanation of the review methods used to evaluate evidence published subsequent to the release of the 2002 recommendations. Five specific topics are examined: 1) treatment indications, 2) tuberculosis screening with biologic DMARDs, 3) adverse effects, 4) efficacy, and 5) treatment selection based on patient preferences and cost. Recommendations for both nonbiologic and biologic DMARDs are presented in 3 separate algorithms based on disease duration. Two additional tables present contraindications to the use of nonbiologic and biologic DMARDs as well as recommondations for laboratory follow-up. 23 Pages. Access checked June 30, 2008.

OARSI Recommendations for the Management of Hip and Knee Osteoarthritis, Part II: OARSI Evidence-Based, Expert Consensus Guidelines

Access: http://www.oarsi.org/pdfs/oarsi_recommendations_for_management_of_hip_and_knee_oa.pdf
Source: Osteoarthritis Research Society International (OARSI)
Date: 2008
Print Reference: Zhang W, Moskowitz RW, Nuki G, et al. Osteoarthritis Cartilage. 2008(Feb);16(2):137-162.
Description: Experts in 4 clinical disciplines from 6 countries evaluated existing guidelines on the management of hip and knee osteoarthritis. The evidence was evaluated and consensus recommendations were developed following a synthesis of expert clinical opinion and the strength of existing recommendations. The guidelines development team determined that optimal management of patients with hip or knee osteoarthritis requires a combination of non-pharmacological and pharmacological treatment modalities. The guideline includes 25 recommendations overall; 8 recommendations are related to the administration of non-opioid pain-relievers and 12 recommendations resulted following a review of the efficacy of non-pharmacological modalities from education to acupuncture. Five surgical recommendations are included. This guideline was developed in a manner that would allow adaptation for use in a variety of clinical settings and geographical regions. Access checked April 28, 2008.

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

Access: http://www.annals.org/cgi/reprint/147/7/478.pdf
Source: American College of Physicians (ACP), American Pain Society (APS)
Date: 2007
Print Reference: Chou R, Qaseem A, Snow V, et al. Annals of Internal Medicine. 2007(Oct);147(7):478-491.
Description: Low back pain is reported to be the fifth most common healthcare complaint in the United States. This evidence-based guideline for the evaluation and treatment of acute and chronic low back pain in primary care settings was developed through a collaborative effort of the ACP and the APS. The guideline focuses on adults presenting with low-back pain unassociated with major trauma, with and without referred leg pain. Two algorithms were developed: 1) diagnostic evaluations and interpretation which can aid clinicians in identifying a general back pain category during the patient’s first visit, and 2) pain management that includes drug and nonpharmacologic therapies. Clinicians are encouraged to use the 7 evidence-based recommendations to expand current treatment modalities and to explore the benefits and drawbacks of traditional treatment methods. Access checked April 24, 2008.

Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline

Access: http://www.annals.org/cgi/reprint/147/7/492.pdf
Source: American Pain Society (APS), American College of Physicians (ACP)
Date: 2007
Print Reference: Chou R, Huffman LH, American Pain Society, American College of Physicians. Annals of Internal Medicine. 2007(Oct);147(7):492-504.
Description: Task force members of the APS and ACP examined systematic reviews and randomized trials on a wide range of nonpharmacologic therapies used to treat acute or chronic low back pain. Studies that reported pain outcomes, back-specific function, general health status, work disability, or patient satisfaction were graded on methodological quality. In the final analysis, four modalities showed good levels-of-evidence for moderate efficacy in the treatment of chronic or subacute low back pain: cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. The only therapy that provided good evidence for effectiveness in acute low back pain was superficial heat. Access checked April 24, 2008.

EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Access: http://ard.bmj.com/cgi/content/full/ard.2005.044354...
Source: European League Against Rheumatism (EULAR)
Date: 2007
Print Reference: Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007(Jan);66(1):34-45.
Description: Recent advances in rheumatology include the use of biological treatments which have demonstrated improved disease control when initiated early in the inflammatory process. Recommendations for the diagnosis, treatment, and continual monitoring of arthritis were developed by expert consensus following a review of the evidence-based literature. Each of twelve recommendations is supported by the level of evidence reflected in a review of 284 manuscripts. These guidelines represent the current knowledge base, available treatment, and present expert thinking on the most effective approach to managing early arthritis. 12 Pages. Access checked April 25, 2008.

Interventional Techniques: Evidence-Based Practice Guidelines in the Management of Chronic Spinal Pain

Access: http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf
Source: American Society of Interventional Pain Physicians (ASIPP)
Date: 2007
Print Reference: Boswell MV, Trescot AM, Datta S, et al. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Pain Phys. 2007;10(1):7-111.
Description: This is the fourth revision of the ASIPP chronic spinal pain practice guidelines and replaces the previous 2005 version. Using an ongoing process to synthesize the evidence, these guidelines continue to represent the most current emerging techniques in interventional therapy by examining the results reported in systematic reviews, randomized trials, retrospective trials, and prospective trials with a minimum of 50 patients in each. Expert opinion and consensus have also been utilized as needed to provide the best evidence available. Algorithms are presented for the comprehensive evaluation of spinal pain, the diagnosis of chronic back pain without disc herniation, the application of therapeutic interventional techniques in the management of chronic low back pain, and the diagnosis of chronic neck pain without disc herniation. 105 Pages. Access checked April 25, 2008.

Adult Low Back Pain

Access: http://www.pain-topics.org/pdf/ICSI-LowBackPain.pdf

Source: Institute for Clinical Systems Improvement (ICSI)
Date: 2006
Description: An identification of symptoms that would indicate the presence of a serious underlying condition requiring urgent care is crucial to the initial patient evaluation. The guideline continues with an emphasis on acute and chronic management of low back pain and sciatica, including the indications for medical, surgical, and non-surgical referral. Discussions of prevention, lifestyle modifications, and self-care treatments are included. 66 Pages. Access checked April 25, 2008.

British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Rheumatoid Arthritis (the first two years)

Access: http://rheumatology.oxfordjournals.org/cgi/data/kel215a/DC1/1
Source: British Society for Rheumatology, British Health Professionals in Rheumatology
Date: 2006
Print Reference: Luqmani R, Hennell S, Estrach C, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (the first two years). Rheumatology (Oxford). 2006(Sep);45:1-16.
Description: This guideline provides 24 evidence-based, graded recommendations for the early management of rheumatoid arthritis. The patient care pathway uses a multi-disciplined approach for assessment, planning, treatment delivery, and the monitoring of effectiveness. 16 Pages. Access checked April 25, 2008.

EULAR Evidence Based Recommendations for Gout. Part I: Diagnosis. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Access: http://ard.bmj.com/cgi/reprint/65/10/1301?ijkey=7jOEXurujRa0k&keytype=ref&siteid=bmjjournals
Source: European League Against Rheumatism
Date: 2006
Print Reference: Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006(Oct);65(10):1301-1311.  
Description: Nineteen rheumatologists representing 13 countries evaluated gout management recommendations and present guidelines that include 10 evidence-based diagnostic tests. A strength of recommendation score is provided for each proposition; radiological testing, biochemical testing, urate crystal analysis, and patient risk factors are evaluated. 12 Pages. Access checked April 25, 2008.

EULAR Evidence Based Recommendations for Gout. Part II: Management. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

Access: http://ard.bmj.com/cgi/reprint/65/10/1312?ijkey=uZK1Nk6Uq8MCs&keytype=ref&siteid=bmjjournals
Source: European League Against Rheumatism
Date: 2006
Print Reference: Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006(Oct);65(10):1312-1324.  
Description: Nineteen rheumatologists representing 13 countries evaluated gout management recommendations and present 12 important evidence-based treatment guidelines. Recommendations range from acute treatment to prophylactic therapy and include patient education and behavioral modification strategies. Pain management approaches are recommended according to the strength-of-evidence and urate lowering therapy is described in detail. 14 Pages. Access checked April 25, 2008.

Guidelines For the Use of Antidepressants in Painful Rheumatic Conditions

Access abstract only: antidepressant/rheumatic
Source: CEDR, French Society of Rheumatology
Date: 2006
Print Reference: Perrot S, Maheu E, Javier RM, et al. Guidelines for the use of antidepressants in painful rheumatic conditions. European J Pain. 2006(Apr);10(3):185-192.
Description: While antidepressants have been used frequently to reduce pain, recommendations for their use in rheumatic conditions were lacking. The investigators identified 49 useful clinical studies in a review of the literature which, along with an expert consensus, were used to develop the recommendations in this guidance document. Specific painful rheumatic conditions are addressed: fibromyalgia, low back pain, osteoarthritis, and inflammatory rheumatic conditions. The analgesic effects of antidepressants are examined and 10 recommendations are made for their use on a level-of-evidence basis. 8 Pages. Access checked April 25, 2008.

Guideline for the Management of Fibromyalgia Syndrome Pain in Adults and Children

Access: http://www.ampainsoc.org/pub/fibromyalgia.htm
Source: American Pain Society
Date: 2005
Description: This peer-reviewed, evidence-based guideline discusses recent advances in the understanding of pain as it relates to fibromyalgia. Diagnosis, assessment, multidisciplinary therapy, and the controversies surrounding fibromyalgia are explored. Available for purchase only through the website (click on the APS Online Store); members $15, non-members $20. 109 Pages. Access checked April 25, 2008.

Knee Pain or Swelling: Acute or Chronic

Access: http://cme.med.umich.edu/pdf/guideline/knee.pdf
Source: University of Michigan Health System
Date: 2005
Description: Assessment and diagnostic evaluation are crucial to diagnosis and effective treatment. Four algorithms have been developed for 1) knee pain without constitutional symptoms, 2) knee pain with constitutional symptoms, 3) traumatic knee pain, and 4) knee effusion. Each algorithm includes diagnostic and evidence-based treatment recommendations. The guideline text includes discussions on differential diagnosis and special considerations for each condition. 13 Pages. Access checked April 25, 2008.

Evidence-Based Management of Acute Musculoskeletal Pain

Access: http://www.nhmrc.gov.au/publications/synopses/_files/cp95.pdf
Source: Australian Acute Musculoskeletal Pain Guidelines Group
Date: 2003
Description: This comprehensive guide begins with a discussion of etiology, effective patient communication, and assessment. The multi-disciplinary review examines five specific symptoms, describes evidence-based interventions for each and provides recommendations; these include acute low back pain, acute thoracic spinal pain, acute neck pain, acute shoulder pain, and acute knee pain. The Australian Government NHMRC (National Health & Medical Research Council) website also offers a PDF version of the 83-page Guide for Clinicians which presents a summary of the findings for the diagnosis, prognosis and interventions of each symptom; available at http://www.nhmrc.gov.au/publications/synopses/cp94syn.htm . 259 Pages. Access checked April 25, 2008.

Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis, 2nd Edition

Access: http://www.ampainsoc.org/pub/arthritis.htm
Source: American Pain Society
Date: 2002
Description: To address the multidimensional dynamic of arthritis pain, this APS guideline uses a multidisciplinary approach by utilizing an ongoing pain assessment, drug therapy, nutrition, exercise, and patient education. Available for purchase only through the website, (click on the APS Online Store); members $15, non-members $20. 184 Pages. Access checked April 25, 2008.

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Neuropathic Pain

Pharmacologic Management of Neuropathic Pain: Evidence-Based Recommendations

Access (National Guideline Clearinghouse summary): http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=11724&nbr=6049
Source: International Association for the Study of Pain, Independent Expert Panel of the Fourth International Conference on the Mechanisms and Treatment of Neuropathic Pain
Date: 2007
Print Reference: Dworkin RH, O’Connor AB, Backonja M, et al. Pain. 2007(Dec 5);132(3):237-251.
Description: Assessment considerations in neuropathic pain include an identification of the underlying disease process, the type of lesion, response to prior therapy, and any comorbid conditions. This guideline provides a stepwise pharmacologic management recommendations table and includes graded support for specific drug treatment based on available therapeutic evidence. Consideration is given to clinical efficacy, adverse effects, potential benefit to health-related quality of life, and treatment costs. 15 Pages. Access checked June 30, 2008.

EFNS Guidelines on Neurostimulation Therapy for Neuropathic Pain

Access: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1468-1331.2007.01916.x
Source: European Federation of Neurological Societies (EFNS)
Date: 2007
Print Reference: Cruccu G, Aziz TZ, Garcia-Larrea L, et al. Eur J Neurol. 2007(Sep);14(9):952-970.
Description: Neuropathic pain relief is oftentimes incomplete with drug therapy alone. The EFNS task force evaluated and classified the evidence for neurostimulation therapy in neuropathic pain conditions. The evidence for the effectiveness of spinal cord stimulation, transcutaneous electrical nerve stimulation, electro-acupuncture, repetitive transcranial magnetic stimulation, motor cortex stimulation, and deep brain stimulation was examined; recommendations were rated according to the evidence for efficacy in specific types of pain disorders. Access checked April 28, 2008.

Consensus Guidelines: Treatment Planning and Options. Diabetic Peripheral Neuropathic Pain

Access: http://www.mayoclinicproceedings.com/pdf/DPNPSuppl.pdf
Source: American Society of Pain Educators and the Johns Hopkins University School of Medicine
Date: 2006
Print Reference: Argoff CE, Backonja MM, Belgrade MJ, et al. Consensus guidelines: treatment planning and options. Diabetic neuropathic pain. Mayo Clinic Proceedings. 2006(Apr);81(Suppl 4):S12-S25.
Description: Diabetic peripheral neuropathic pain requires attention to many factors including existing comorbidities and potential adverse effects of treatment. A thorough evidence-based discussion of pharmacologic therapies includes antidepressants, anticonvulsants, opioids, and topical agents. Recommendations are made for 1st and 2nd tier therapeutic agents, including a table of factors to consider in drug selection. Guidelines are offered for monitoring the patient’s pain management and modifying therapy. 14 Pages. Access checked April 25, 2008.

EFNS Guidelines on Pharmacological Treatment of Neuropathic Pain

Access:http://www.efns.org/files/guideline_50.pdf   
Source: European Federation of Neurological Societies
Date: 2006
Print Reference: Attal N, Cruccu G, Haanpaa M, et al. EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol. 2006(Nov);13(11):1153-1169.
Description: The management of neuropathic pain continues to provide challenges for the practitioner. This paper summarizes the evidence-based treatment for painful polyneuropathy (diabetic and non-diabetic), postherpetic neuralgia, trigeminal neuralgia, central neuropathic pain, and several conditions for which very few studies were available. The mechanism of action, efficacy and adverse effects were presented and recommendations were made for antidepressants, antiepileptics, opioids and the combination regimen. 17 Pages. Access checked April 25, 2008.

EFNS Guidelines on Neuropathic Pain Assessment

Access:http://www.efns.org/files/guideline_20.pdf  
Source: European Federation of Neurological Societies
Date: 2004
Print Reference: Cruccu G, Anand P, Attal N, et al. EFNS guidelines on neuropathic pain assessment. Eur J Neurol. 2004(Mar);11(3):153-162.
Description: The assessment of neuropathic pain is crucial to an accurate diagnosis and the development of an effective treatment protocol.  This guideline provides recommended testing methods that are the result of a systematic review of the evidence-based studies on neuropathic pain assessment. In addition, a description and graded evidence for effectiveness is provided for electrodiagnostic studies, microneurography, laser-evoked potentials, reflex testing, biopsy and functional neuroimaging studies. 10 Pages. Access checked April 25, 2008.

Practice Parameter: Treatment of Postherpetic Neuralgia. An Evidence-Based Report of the Quality Standards Subcommittee of the American Academy of Neurology

Access: http://www.neurology.org/cgi/reprint/63/6/959.pdf
Source: Quality Standards Subcommittee of the American Academy of Neurology
Date: 2004
Print Reference: Dubinsky RM, Kabbani H, El-Chami Z, at al. Practice parameter: treatment of postherpetic neuralgia. An evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004(Sep 28);63(6):959-65.
Description: The recommendations derived from the evidence of 51 studies in this systematic review are categorized and summarized in 4 classes of pharmacological treatment. 7 Pages. Access checked April 25, 2008.

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Non-Opioid & Complementary Therapies

Antiepileptic Drugs Guideline for Chronic Pain

Access: http://www.lni.wa.gov/ClaimsIns/Files/Providers/ProvBulletins/PbFiles/PB0510.pdf
Source: Washington State Department of Labor and Industries
Date: 2005
Description: Based on expert opinion and a systematic review of the literature, these guidelines make a summary statement about the lack of evidence for several antiepileptics and primarily focus on the use of Gabapentin for neuropathic pain. A dosing plan is recommended and adverse effects are stated. 3 Pages. Access checked April 25, 2008.

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Opioid Therapy & Safety

Opioids in the Management of Chronic Non-Cancer Pain: An Update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines

Access: http://www.painphysicianjournal.com/2008/april/2008;11;S5-S62.pdf
Source: American Society of Interventional Pain Physicians
Date: 2008
Print Reference: Trescot AM, Helm S, Hansen H, et al. Pain Physician. 2008(Mar);11(Suppl 2):S5-S62.
Description: The ASIPP guidelines for the use of opioids in the treatment of chronic non-cancer pain have been updated following an evaluation of evidence-based treatment in randomized clinical trials, systematic reviews, and observational trials since the last guidelines published in 2005. In light of evidence that shows a wide variance in the use of opioids, the primary objective of this revision is to provide concise guidelines that improve patient access to opioids while avoiding diversion and abuse. The pharmacology and efficacy of specific opioids is described, principles of use are reviewed, and issues related to improving patient education—their rights as well as their responsibilities—during opioid therapy are discussed. A 10-step approach for the management of long-term opioid therapy is described. 58 Pages. Access checked June 30, 2008.

Guidelines for the Use of Methadone in Office-Based Management of Chronic Non-Cancer Pain and A Review of the Use of Methadone for Treatment of Chronic Non-Cancer Pain

Access: http://www.cpsns.ns.ca/publications/2006-methadone-pain-guidelines.pdf
Source: College of Physicians & Surgeons of Nova Scotia
Date: 2006
Description: The use of methadone in cases where conventional opioid therapy is inappropriate or has failed is increasing and this guideline serves as a comprehensive guide to its use in chronic non-cancer treatment. The unique characteristics of methadone are reviewed, contraindications are discussed, and guidelines for initiating a trial regimen, including dosing and conversion ratios, are presented. Tables include 1) studies with varied protocols for opioid conversion to methadone, 2) a morphine to methadone dose conversion ratio, and 3) a list of potential drug-drug interactions. Costs listed in this paper are based on Canadian currency. 50 Pages. Access checked April 25, 2008.

Methadone for Pain Guidelines

Access: http://www.cpso.on.ca/Publications/methpain.pdf
Source: College of Physicians and Surgeons of Ontario
Date: November 2004
Description: These guidelines were developed to assist clinicians in the use of methadone to treat chronic pain. Due to increasing interest in methadone’s analgesic properties, this guideline attempts to provide sufficient information to clarify any potential confusion that may relate to it’s use. Pharmacology and duration of action are explained and the issue of variations in individual patient response to methadone is discussed. Prescribing options for acute and chronic pain in specific patient populations are presented; these include opioid naïve patients, individuals in methadone maintenance, patients who are being switched from another opioid, and others. Some of the information for pharmacists is based on Canadian standards of practice, but other clinical recommendations for methadone withdrawal and cautions regarding drug interactions are universally appropriate. 58 Pages.  Access checked April 25, 2008.

VA/DoD Clinical Practice Guideline for the Management of Opioid Therapy for Chronic Pain

Access: http://www.Pain-Topics.org/pdf/VA_OpioidsChronicPain_Guide.pdf
Source: Department of Veterans Affairs and the Department of Defense
Date: 2003 (Version 1.0)
Description: Designed for use in an ambulatory setting, the guideline provides all levels of information from assessment to contraindications and patient education. Recommendations and algorithms for to all three phases of opioid management are defined: the initiation phase, the titration phase and maintenance. Assessments of efficacy, nonadherence, adverse effects, and follow-up are explored. 111 Pages. Access checked April 25, 2008.

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Pain in Palliative Care

Consensus Guideline on Parenteral Methadone Use in Pain and Palliative Care

Access (abstract only): http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1885928
Source: Cambridge Journals Online
Date: 2008
Print Reference: Shaiova L, Berger A, Blinderman CD, et al. Palliat Support Care. 2008(Jun);6(2):165-176.
Description: Consensus guidelines were developed by expert practitioners from 8 palliative care facilities to assist clinicians with the use of parenteral methadone for patients with life-limiting illnesses. The authors provide recommendations for opioid conversion and methadone dosing that could allow the drug to be used as a first- or second-line therapy to benefit palliative care patients. 12 Pages. Access checked June 30, 2008.

Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians

Access: http://www.annals.org/cgi/reprint/148/2/141.pdf
Source: American College of Physicians (ACP)
Date: 2008
Print Reference: Qaseem A, Snow V, Shekelle P, et al. Annals of Internal Medicine. 2008(Jan);148(2):141-146.
Description: This guideline, written for all practitioners caring for patients who need end-of-life care, begins with a working definition for end-of-life. Based on the 2003 report from the Institute of Medicine on the weaknesses in palliative care as well as a synthesis of existing evidence for effective end-of-life care, 5 recommendations were developed. The guideline only presents interventions with strong to moderate evidence for the management or prevention of the symptoms of pain, dyspnea, and depression. It does not address many other important aspects of physical, psychological and social needs at the end of life. Access checked April 24, 2008.

Clinical Practice Guidelines for Quality Palliative Care

Access: http://www.nationalconsensusproject.org/Guideline.pdf
Source: National Consensus Project for Quality Palliative Care
Date: 2004
Description: These guidelines for palliative care were developed to promote consistent high quality care in a variety of healthcare settings. Models of assessment and care that integrate multiple disciplines are presented. While pain management is not addressed on a treatment level, guidelines are provided that cover the process of integrating physical palliative care with psychological, social, spiritual, cultural and ethical components. 76 Pages. Access checked April 25, 2008.

Procedure Guideline for Palliative Treatment of Painful Bone Metastases

Access: http://interactive.snm.org/index.cfm?PageID=804&RPID=772
Source: Society of Nuclear Medicine
Date: 2003
Description: Radiopharmaceuticals are approved for the treatment of bone pain in patients with metastatic malignancy in multiple skeletal sites. This guideline is the result of a systematic review of the literature with a subsequent analysis and compilation of procedural recommendations for intravenous injection of radiopharmaceuticals by the Guideline Development Subcommittee and Task Force. The recommendations cover patient preparation, instructions for patients, precautions, guidelines for dosing, measurement of the agent activity, interventions reporting, quality issues and potential complications. 8 Pages. Access checked April 25, 2008.

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Pediatric Pain

Consensus Guidelines for Sustained Neuromuscular Blockade in Critically Ill Children

Access: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1460-9592.2007.02313.x
Source: United Kingdom Paediatric Intensive Care Society Sedation, Analgesia and Neuromuscular Blockade Working Group
Date: 2007
Print Reference: Playfor S, Jenkins I, Boyles C, et al. Paediatric Anaesthesia. 2007(Sep);17(9):881-887.
Description: This multidisciplinary consensus guideline was developed through multiple consensus conferences and a systematic review of the literature. The authors state that this is the first set of guidelines on sedation, analgesia and maintenance neuromuscular blockade in the critically ill pediatric patient (not including neonates). The guideline includes 6 key levels-of-evidence recommendations and the Working Group recommends the implementation of further trials in this area. Access checked April 25, 2008.

Pediatric Cancer Pain

Access: http://www.nccn.org/professionals/physician_gls/PDF/pediatric_pain.pdf
Source: National Comprehensive Cancer Network
Date: 2007
Description: The Pediatric Cancer Pain guideline is written in an easy-to-use format and includes algorithms for evaluation, initial treatment, and follow-up treatment. Additional tools include a conversion table for fentanyl administration and a titration algorithm for both slow and rapid administration of short-acting opioids. A guide to reducing the pain and anxiety of procedure-related pain as well as the management of opioid adverse effects in children is included. An NSAID table contains information on the risk of toxicity in pediatric patients. 31 pages. Access checked April 28, 2008.

Guideline Statement: Management of Procedure-Related Pain in Children and Adolescents

Access journal citation only: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-1754.2006.00798_2.x
Source: Royal Australasian College of Physicians
Date: 2006
Print Reference: Guideline statement. Management of procedure-related pain in children and adolescents. Journal of Paediatrics and Child Health. 2006(Feb);42(Suppl 1):S2-S30.
Description: Based on the theory that children experience more pain that necessary during procedures, this guideline begins with an examination of the assessment of pain and anxiety and continues with a discussion of the consequences of under-treating pain. An evaluation of the child and an assessment of appropriate preparations prior to the procedure are important steps before implementing recommended environmental, behavioral, and pharmacological techniques. Levels of evidence recommendations are made for a very comprehensive list of procedures from suturing a laceration or biopsy site to tube insertion and removal. Special considerations for children with communication problems are discussed. 29 Pages. Access checked April 25, 2008.

Guideline Statement: Management of Procedure-Related Pain in Neonates

Access journal citation only: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-1754.2006.00799_2.x
Source: Royal Australasian College of Physicians
Date: 2006
Print Reference: Guideline statement. Management of procedure-related pain in neonates. Journal of Paediatrics and Child Health. 2006(Feb);42(Suppl 1):S31-S39.
Description: The guideline begins with a discussion of the consequences of neonatal pain and continues with pain assessment techniques. Strength of evidence recommendations for pain reduction from blood sampling to tube insertion and laser therapy are presented. Guidance is offered for preventive pain measures as well as environmental, behavioral, procedural, and pharmacological modifications for each procedure. 9 Pages. Access checked April 25, 2008.

Practice Parameter: Evaluation of Children and Adolescents With Recurrent Headaches

Access: http://www.neurology.org/cgi/reprint/59/4/490.pdf
Source: Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society
Date: Guideline re-affirmed in October 2005
Print Reference: Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches. Neurology. 2002(Aug);59(4):490-498.
Description: Diagnostic guidelines are based on 4 levels of evidence for recommendation. A discussion on the use of routine laboratory studies, lumbar puncture, EEG testing and neuroimaging is based on evidence of appropriateness following the clinical neurological examination. 9 Pages. Access checked April 25, 2008.

Clinical Report: Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

Access: http://pediatrics.aappublications.org/cgi/content/full/114/5/1348
Source: American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine
Date: 2004
Print Reference: Zempsky WT, Cravero JP. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004(Nov);114(5):1348-56.
Description: Emergency department pain management can minimize distress and pain in children if a systematic approach is used. The environment, staff education, use of protocols, and new modalities of pain control can help manage this complex element of emergency care. Guidelines are provided for triaging oral analgesics, the use of EMLA/LMX4, the placement of topical anesthetics on open wounds, and the use of sucrose in neonates. This document is titled "clinical report"; however, it is included in the Clinical Guidelines section on the American Academy of Pediatrics website. 9 Pages. Access checked April 25, 2008.

Practice Parameter: Pharmacological Treatment of Migraine Headache in Children and Adolescents

Access: http://www.neurology.org/cgi/reprint/63/12/2215.pdf
Source: American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society
Date: 2004
Print Reference: Lewis D, Ashwal S, Hershey A, et al. Practice Parameter: Pharmacological treatment of migraine headache in children and adolescents. Neurology. 2004(Dec 28);63(12):2215-2224.
Description: The authors reviewed 166 articles on the acute and preventive pharmacological treatment of children and adolescents. Recommendations are made according to the strength of evidence. The authors state that "there is a paucity of controlled data regarding the treatment of primary headache disorders” in this population and make 7 recommendations for further study. 10 Pages. Access checked April 25, 2008.

Special Treatment Situations: Pediatric Migraine. Standards of Care for Headache Diagnosis and Treatment

Access:
http://www.guideline.gov/summary/summary.aspx?doc_id=6586&nbr=004146&string=acute+AND
+migraine+AND+treatment
Source: National Headache Foundation (NHF)
Date: 2004
Print Reference: Pearlman E. Special treatment situations: pediatric migraine. In: Standards of care for headache diagnosis and treatment. Chicago (IL): National Headache Foundation; 2004. p. 98-107.
Description: Diagnosis requires a thorough evaluation that includes a questioning of both parents as well as the patient. Childhood migraine variants and proposed diagnostic criteria for the pediatric migraine with and without aura are outlined. Pharmacologic, non-pharmacologic, and prophylaxis treatment s are discussed. A print copy of the 122-page book, Standards of Care for Headache Diagnosis and Treatment is available for $12 from the NHF by calling 888-NHF-5552. The link shown above provides an abbreviated version from the National Guideline Clearinghouse. 10 Pages. Access checked April 25, 2008.

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Perioperative Pain

ASPAN Pain and Clinical Comfort Guideline

Access: http://www.aspan.org/PDFfiles/pain&comfort.pdf
Source: American Society of PeriAnesthesia Nurses
Print Reference: ASPAN pain and comfort clinical guideline. J Perianesth Nurs. 2003(Aug);18(4):232-6.
Description: Guidelines for the perianesthesia environment begin with the pre-operative assessment and continue through postanesthesia phases I/II/III assessments, interventions, and expected outcomes. Complementary non-pharmacologic strategies are included in this nursing care plan protocol. 5 Pages. Access checked April 25, 2008.

Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management

Access: http://www.asahq.org/publicationsAndServices/pain.pdf
Source: American Society of Anesthesiologists - Medical Specialty Society
Date: 2003 (Originally published in 1995)
Description: This updated report was designed to review recent evidence-based studies and revise recommendations on acute pain management in the perioperative setting to improve efficacy and safety while reducing the risk of adverse outcomes. The guidelines address: 1) institutional policies, 2) preoperative patient evaluation, 3) preoperative preparation, 4) perioperative pain management including multimodal techniques, and 5) subpopulations at greater risk. 21 Pages. Access checked April 25, 2008.

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Outdated Guidelines of Importance

The following guidelines were published over 6 years ago but will be maintained in this section for an additional period of time because they address important topics and have not been superseded by more current guidelines. Due to the limited number of outdated guidelines, they are simply arranged by publication date; newer guidelines are near the top.

Opioid Guidelines in the Management of Chronic Non-Cancer Pain

Access: http://www.asipp.org/documents/1-40-OpioidGuidelines.pdf
Source: American Society of Interventional Pain Physicians
Date: 2006
Print Reference: Trescot AM, Boswell MV, Sairam LA, et al. Opioid Guidelines in the Management of Chronic Non-Cancer Pain. Pain Physician. 2006(Jan);9:1-40.
Description: Guidelines for the use of opioids in the treatment of chronic non-cancer pain are developed from an evaluation of evidence-based approaches in randomized clinical trials, systematic reviews, and observational trials. The pharmacology and efficacy of specific opioids is described, principles of use are reviewed, and issues related to monitoring adherence are discussed. 40 Pages. Access checked April 25, 2008.

Guidelines for the Management of Rheumatoid Arthritis

Access: http://www.rheumatology.org/publications/guidelines/raguidelines02.asp?aud=mem
Source: American College of Rheumatology
Date: 2002
Print Reference: American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis. 2002 Update. Arthritis & Rheumatism. 2002(Feb);46(2):328-346.
Description: The evidence-based guidelines begin with a baseline patient evaluation after diagnosis and further recommend early treatment with periodic reassessments to modify therapy for maximum effectiveness. A table presents the evidence of DMARD efficacy by single agent or combination treatment modalities. Effectiveness, adverse effects, and cost issues are discussed for certain specific therapeutic recommendations. 19 Pages. Access checked September 27, 2006.

ASIPP Practice Guidelines: Interventional Techniques in the Management of Chronic Pain: Part 2.0

Access: http://www.asipp.org/documents/ASIPP_Guidelines%20II.PDF
Source: American Society of Interventional Pain Physicians
Date: 2001
Print Reference: Manchikanti L, Singh V, Kloth D, et al. Interventional techniques in the management of chronic pain: part 2.0. Pain Physician. 2001(Jan);4(1):24-98.
Description: This guideline expands on the information provided in Part 1.0 by presenting comprehensive evidence, including the advantages and disadvantages, for specific procedures including epidural injections, facet joint blocks, and spinal cord stimulation. Clinical algorithms for chronic somatic and radicular spinal pain are presented; emphasis is placed on systematic evaluation and ongoing care. 75 Pages. Access checked April 25, 2008.

Exercise Prescription for Older Adults With Osteoarthritis Pain: Consensus Practice Recommendations

Access: http://www.americangeriatrics.org/products/positionpapers/oae_guidelines.pdf
Source: American Geriatrics Society (AGS)
Date: 2001
Print Reference: Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. A supplement to the AGS Clinical Practice Guidelines on the management of chronic pain in older adults. J Am Geriatr Soc. 2001 Jun;49(6):808-23.
Description: These AGS practice recommendations are derived from an evidence-based review of the literature and by consensus among a panel of experts from many disciplines: geriatrics, internal medicine, orthopedics, physical therapy/rehabilitation, exercise physiology, nursing, and pharmacy. The guideline makes recommendations on patient screening and the need for graded exercise testing, as well as basic exercise principles and pain-reduction strategies. 16 Pages. Access checked April 25, 2008.

Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Knee Pain

Access: www.ptjournal.org
Source: Philadelphia Panel
Date: 2001
Print Reference: Philadelphia Panel. Evidence-based clinical practice guidelines on selected rehabilitation interventions for knee pain. Physical Therapy. 2001(Oct);81(10):1675-1700.
Description: Chronic knee pain can be the result of a disease process like osteoarthritis or it can be the result of musculoskeletal strain injuries or overuse. The Philadelphia Panel reviewed, graded and synthesized the evidence-based literature on 8 nonpharmacologic treatment modalities. In addition, the results of a survey that was developed on the 2 most positive rehabilitation interventions, and sent to 324 practitioners, were integrated into the final recommendations. Evaluation results showed efficacy for therapeutic exercise and transcutaneous electrical nerve stimulation (TENS) for certain indications, while a lack of evidence was apparent for thermotherapy, therapeutic massage, electromyographic biofeedback, ultrasound, and electrical stimulation. The Panel examines and presents the levels of evidence for all interventions and indications. 26 Pages. Access checked April 25, 2008.

Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease

Access: http://www.ampainsoc.org/pub/sc.htm
Source: American Pain Society
Date: 2000
Description: An overview of sickle cell disease and the associated pain experience is described in this guideline. The pain assessment section includes a discussion of acute and chronic pain in the developmental stages of sickle cell disease. Pain management recommendations are multi-disciplined in approach and cover pharmacologic and nonpharmacologic therapies. Available for purchase only through the website (click on the APS Online Store); members $10, non-members $15. 60 Pages. Access checked April 25, 2008.

Practice Guidelines: Interventional Techniques in the Management of Chronic Pain: Part 1.0

Access: http://www.asipp.org/documents/Guidelines1.pdf
Source: American Society of Interventional Pain Physicians
Date: 2000
Print Reference: Manchikanti L, Singh V, Bakhit CE, et al. Interventional techniques in the management of chronic pain: part 1.0. Pain Physician. 2000(Jan);3(1):7-42.
Description: Various interventional techniques and recommendations are presented in these practice guidelines following a review of published evidence and expert consensus. The pathophysiology of chronic pain is discussed, but the focus of the guideline is the effectiveness, feasibility and cost-benefit ratio of using interventional techniques in diagnostic and therapeutic aspects of pain management. 36 Pages. Access checked April 25, 2008.

Practice Parameter: Evidence-Based Guidelines for Migraine Headache

Access: http://www.neurology.org/cgi/content/full/55/6/754
Source: Quality Standards Subcommittee of the American Academy of Neurology
Date: 2000
Print Reference: Silberstein SD. for the US Headache Consortium. Practice parameter: Evidence-based guidelines for migraine headache (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000(Sep); 55(6):754-762.
Description: This guide summarizes the results of 4 evidence-based reviews on the treatment of patients with migraine. A multidisciplinary panel from 7 professional organizations (The US Headache Consortium) produced treatment guidelines for 4 distinct management decisions: diagnostic testing (primarily neuroimaging studies), pharmacologic management of acute attacks, migraine-preventive drugs, and behavioral and physical treatments for migraine. 9 Pages. Access checked April 25, 2008.

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