Clinical practice guidelines for chronic non-malignant pain syndrome patients II: An evidence-based approach

The current article provides evidence-based revisions to the practice guidelines for treating chronic non-malignant pain syndrome patients published in 1995 and adopted by the American Academy of Physical Medicine and Rehabilitation in 1996. Like the 1995 guidelines, the current ones are applicable to chronic pain syndrome patients, except cancer pain, regardless of general etiology of pain. They recommend that treatment continue to be goal directed across eight clinical and economic goals, with evaluation and treatment provided in an interdisciplinary, integrated fashion. Improvement in patient function continues to be emphasized, as does outpatient intervention; delivered with a blend of medical, psychological/behavioral, physical/occupational therapy, and vocational interventions in an individualized treatment plan. Updates and/or new recommendations are provided with regard to the use of opioids and sedative-hypnotic medications, trigger point injections, nerve blocks, surgery, implantable spinal infusion and stimulation devices, and acupuncture based upon the most recent empirical research. The current guidelines continue to recommend upper limits regarding the number of treatment days and specific recommendations about patient selection. There is a new section discussing areas in need of additional evidence and a possible conceptual model allowing integration of the current guidelines with the ever-increasing number of others appearing in the clinical and research literature.