Laxmaiah Manchikanti, Pain Management Centers of America
Adam M. Kaye, University of the PacificFollow
Nebojsa Nick Knezevic, University of Illinois at Chicago
Heath McAnally, Northern Anesthesia and Pain Medicine, LLC
Andrea M. Trescot, The Pain & Headache Center
Susan Blank, Atlanta Healing Center Atlanta Healing Center, LLC
Vidyasagar Pampati, Pain Management Center Paducah
Salahadin Abdi, University of Texas Health Science Center at Houston
Jay S. Grider, University of Kentucky College of Medicine
Alan David Kaye, Louisiana State University Health Science Center
Kavita N. Manchikanti, Pain Management Center Paducah
Harold J. Cordner, Florida State University College of Medicine
Christopher G. Gharibo, NYU Langone Orthopedic Hospital
Michael E. Harned, University of Kentucky College of Medicine
Sheri L. Albers, Radiology Research and Consultation
Sairam Atluri, Tri-State Spine Care Institute
Steve M. Aydin, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Sanjay Bakshi, Manhattan Spine and Pain Medicine
Robert Barkin, NorthShore University HealthSystem
Ramsin M. Benyamin, Millennium Pain Center
Mark V. Boswell, University of Louisville
Ricardo M. Buenaventura, Pain Relief of Dayton
Aaron K. Calodney, Texas Spine and Joint Hospital
David L. Cedeno, Illinois State University
Sukdeb Datta, Icahn School of Medicine at Mount Sinai
Timothy R. Deer, West Virginia University School of Medicine Morgantown
Bert Fellows, Pain Management Center Paducah
Vincent Galan, Georgia Pain Care
Vahid Grami, Geisinger Medical Center
Hans Hansen, Pain Relief Centers
Standiford Helm, The Helm Center for Pain Management


Adam M. Kaye: 0000-0002-7224-3322

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Background: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl. Contrary to scientific evidence of efficacy and negative recommendations, a significant proportion of physicians and patients (92%) believe that opioids reduce pain and a smaller proportion (57%) report better quality of life. In preparation of the current guidelines, we have focused on the means to reduce the abuse and diversion of opioids without jeopardizing access for those patients suffering from non-cancer pain who have an appropriate medical indication for opioid use. Objectives: To provide guidance for the prescription of opioids for the management of chronic non-cancer pain, to develop a consistent philosophy among the many diverse groups with an interest in opioid use as to how appropriately prescribe opioids, to improve the treatment of chronic non-cancer pain and to reduce the likelihood of drug abuse and diversion. These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique. Methods: The methodology utilized included the development of objectives and key questions. The methodology also utilized trustworthy standards, appropriate disclosures of conflicts of interest, as well as a panel of experts from various specialties and groups. The literature pertaining to opioid use, abuse, effectiveness, and adverse consequences was reviewed, with a best evidence synthesis of the available literature, and utilized grading for recommendation as described by the Agency for Healthcare Research and Quality (AHRQ).

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Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License