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Instead of looking at how to treat a given diagnosis, such as low back pain, the guideline examines the evidence to support the use of a broad range of interventions to treat chronic pain.”
The objectives are to optimize pain control, enhance physical and psychological well-being, and minimize adverse outcomes.

The recommendations apply to patients with chronic noncancer, neuropathic, somatic, or visceral pain. The task force focused on interventional diagnostic procedures including diagnostic joint block, nerve block, and neuraxial opioid trials.

The 12-member task force consisted 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 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.

The new guidelines advocate for multimodal interventions for patients with chronic pain. The task force 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 task force defines chronic pain as pain of any cause 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, nonsteroidal anti-inflammatories, opioid therapy, skeletal muscle relaxants, and topical agents. The task force discusses each in detail and recommends strategies for monitoring and managing adverse effects and patient compliance.

The new guidelines are generally supportive of interventional procedures and are not entirely congruent with other recent guidelines. The process varies among groups, and this will have an impact on recommendations. There is obvious financial self-interest for pain specialists to want recommendations that support use of procedures that they perform.

Ref:  http://www.medscape.org/viewarticle/719781?src=cme_mp_top