By Allison Gandey
Medscape Medical News

April 1, 2010 — For the first time in more than a decade, an American Society of Anesthesiologists taskforce has updated its chronic pain guidelines.

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.

Richard Rosenquist, MD, from the University of Iowa Hospital, Iowa City, led the 12-member taskforce of anesthesiologists in both private and academic practice from various parts of the United States. The group also worked with members of the American Society of Regional Anesthesia and Pain Medicine.

The new guidelines appear 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.

Focus on Interventional Diagnostic Procedures

The team agreed that findings from the patient history, physical examination, and diagnostic evaluation should be combined to provide an individualized treatment plan focused on optimizing the risk-to-benefit ratio. Treatment should progress from a lesser to greater degree of invasiveness.

"Whenever possible," the taskforce reports, "direct and ongoing contact should be made and maintained with the other physicians caring for the patient to ensure optimal care."

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,
botulinum toxin,
electrical nerve stimulation,
epidural steroids,
intrathecal drug therapies,
minimally invasive spinal procedures,
pharmacologic management,
physical therapy,
psychological treatment, and
trigger point injections.
The taskforce defines chronic pain as pain of any etiology not directly related to neoplastic involvement associated with a medical condition or extending in duration beyond the expected temporal boundary of tissue injury and normal healing and adversely affecting the function or well-being of the individual.

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.

The new guidelines cover a range of advances not included in the initial version published in 1997. As a result, the number of pages has more than doubled in the new publication. The complete guidelines are available online.

Financial disclosures for the 12 members of the American Society of Anesthesiologists taskforce were not provided.

Anesthesiology. 2010;112:810-833.


作者:Allison Gandey


  【】April 1, 2010 — 十多年來第一次,美國麻醉科醫師特別工作小組更新了它的慢性疼痛指引。  

  愛荷華市愛荷華大學醫院的Richard Rosenquist醫師領導來自美國各地的開業與學界麻醉科醫師組成的12人特別工作小組,此一小組也和美國地區麻醉及疼痛醫學會成員合作。
  * 燒灼技術
  * 針灸 
  * 阻斷 
  * 肉毒桿菌 
  * 電子神經刺激 
  * 硬脊膜外類固醇 
  * 腦脊髓膜內藥物治療 
  * 微創脊椎手術 
  * 藥物處置 
  * 物理治療 
  * 心理治療 
  * 激痛點注射 


如果你對於慢性疼痛有興趣,這邊可考慮看看:Glia pain或是雙面 ATP (The double life of ATP)




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