Guidelines for the use of controlled substances in the management of chronic pain.

Controlled substance abuse has increased at an alarming rate. However, available evidence suggests a wide variance in the use of controlled substances, as documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration. The primary objective of controlled substance guidelines by American Society of Interventional Pain Physicians (ASIPP) is to provide guidance for the use of controlled substances for the treatment of chronic pain. It is anticipated that these practical guidelines will improve quality of care, patient access, and quality of life. Additional benefits include improved treatment efficiency and efficacy, and cost containment by improving the risk-benefit ratio of treating patients with chronic pain. Further goals of this manuscript are to bring consistency in opioid philosophy among the many diverse groups involved, to improve the treatment of chronic pain patients with medically appropriate controlled substances, and to reduce the incidence of drug diversion. These guidelines also reinforce the need for systematic evaluation and ongoing care of patients with chronic or persistent pain. ASIPP controlled substance guidelines also provide a discussion of the epidemiology of chronic pain, the role of controlled substances in treating chronic pain, various aspects of drug abuse, pharmacological considerations, clinical effectiveness of controlled substances, options for treatment monitoring and drug testing and a review of terminology used in addiction medicine. These guidelines do not constitute inflexible treatment recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, controlled substance prescribing and treatment different from that outlined here may be warranted. These guidelines do not represent "standard of care."