A Clinical Practice Guideline for Pain Management in the Post-Anesthesia Care Unit

Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and ASCO each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.

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Adoptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study

Supportive Care in Cancer ◽

10.1007/s00520-014-2472-0 ◽

2014 ◽

Vol 23 (5) ◽

pp. 1409-1420 ◽

Cited By ~ 5

Author(s):

Nienke te Boveldt ◽

Myrra Vernooij-Dassen ◽

Kees Besse ◽

Kris Vissers ◽

Yvonne Engels

Keyword(s):

Clinical Practice ◽

Pain Management ◽

Cancer Pain ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Case Vignette ◽

Evidence Based ◽

Cancer Pain Management ◽

Vignette Study ◽

Medical Oncologists

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Acute Pain Management: Operative or Medical Procedures and Trauma

Annals of Pharmacotherapy ◽

10.1177/106002809703100917 ◽

1997 ◽

Vol 31 (9) ◽

pp. 1068-1076 ◽

Cited By ~ 35

Author(s):

Sheryl L Follin ◽

Scott L Charland

Keyword(s):

Clinical Practice ◽

Pain Management ◽

Acute Pain ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Pain Assessment ◽

Opioid Analgesics ◽

Data Sources ◽

Medical Procedures ◽

Acute Pain Management

Objective To review the topics presented in the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for Acute Pain Management and provide updated information on therapeutic issues as necessary. Data Sources AHCPR Clinical Practice Guideline for Acute Pain Management: Operative or Medical Procedures and Trauma. A MEDLINE search (1990 to June 1996) of English-language literature pertaining to pain assessment and management was performed. Reference lists from relevant articles also served as a literature source. Study Selection and Data Extraction All articles identified from the data sources were evaluated. Relevant information, as determined by the authors, was included in the review. Data Synthesis Inadequate acute pain management continues to be recognized as a problem due to limited health professional education on the treatment of pain, inadequate patient empowerment, negative connotations associated with opioid analgesics (e.g., fear of “addiction”), federal regulations associated with prescribing opioid analgesics, and difficulty in assessing pain. The widespread inadequacy in pain management prompted the development of the AHCPR Clinical Practice Guideline for Acute Pain Management, which was published in 1992. In addition to reviewing the pain guideline, this article includes updated information on ketorolac tromethamine, tramadol, local anesthetics, sedation, regional anesthetic techniques, and the management of opioid adverse effects. Conclusions The AHCPR Clinical Practice Guideline for Acute Pain Management is a comprehensive, yet functional, review for clinicians. Most issues relating to acute pain assessment and management are adequately discussed. Overall, this guideline is a worthwhile general resource to clinicians. It is important, however, for clinicians managing acute pain issues to supplement this guideline with more detailed and current information.

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