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April 3, 2019

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A Clinical Overview of Off-label Use of Gabapentinoid Drugs

The gabapentinoid drugs gabapentin and pregabalin were originally developed as antiseizure drugs but now are prescribed mainly for treatment of pain. For gabapentin, the only pain-related indication approved by the US Food and Drug Administration (FDA) is postherpetic neuralgia. For pregabalin, FDA-approved indications related to pain are limited to postherpetic neuralgia, neuropathic pain associated with diabetic neuropathy or spinal cord injury, and fibromyalgia.

AHRQ Seeks Input on Headaches in Pregnancy and Acute Pain

The Agency for Healthcare Research and Quality (AHRQ) has posted key questions for the systematic review on Management of Primary Headaches in Pregnancy for comment through April 11, as well as a draft technical brief on the Treatment for Acute Pain for feedback through April 25. AAPM’s Headache and Orofacial Pain Medicine SIG and Acute Pain Medicine SIG are discussing possible Academy comments. AAPM members are encouraged to consider commenting as individuals.

AAPM Statement on Scope of Practice in Pain Medicine

Scope of Practice in Pain Medicine

A position statement from the American Academy of Pain Medicine

Whereas, The American Academy of Pain Medicine is dedicated to the safe and appropriate care of the patient suffering from pain through the practice of Pain Medicine.

Whereas, The American Academy of Pain Medicine (AAPM) believes that a Pain Medicine practitioner is a physician who, by academic medical degree and clinical post-graduate training, board certification, continuing medical education in Pain Medicine and a license to practice medicine, is uniquely qualified to provide a comprehensive array of professional services related to the medical specialty of Pain Medicine. The practice of this specialty involves the identification, diagnosis and treatment of persons with chronic pain symptoms, and often complex, chronic pain conditions to which many diseases may contribute.

Whereas, The medical specialty of Pain Medicine is currently recognized by the American Board of Pain Medicine and by the American Board of Medical Specialties as a subspecialty of anesthesiology, physical medicine and rehabilitation, neurology, and psychiatry.

Whereas, The American Academy of Pain Medicine believes that the physician is called upon to make continuing adjustments based on medical judgments drawn from patient response to treatment. With regard to interventional therapies (e.g., injections, surgical procedures), it is not the procedures itself, but the purpose and manner in which such procedure is utilized, that demands the ongoing application of direct and immediate medical judgment, which constitutes the practice of medicine. A non-physician may have education, training and, indeed, expertise in such area but expertise cannot, in and of itself, supply authority under law to practice medicine.

Whereas, The American Academy of Pain Medicine believes that hospital credentialing committees must have policies in place that restrict credentialing of non-physician clinicians for positions that are not within their respective scope of practice.

Whereas, The American Academy of Pain Medicine encourages and supports state medical boards and state medical societies in adopting advisory opinions and advancing legislation, respectively, that the practice of Pain Medicine constitutes the practice of medicine.

Whereas, The American Academy of Pain medicine believes that the practice of the Specialty of Pain Medicine includes the diagnosis and treatment of a variety of acute and chronic medical conditions, many of which are lifelong in duration, and may be life-threatening in severity. As such, the practice of the Specialty requires postgraduate medical training sufficient for expertise in the diagnosis and multimodal management of the full spectrum of pain conditions, which regularly entails the ongoing utilization of medical decision making requiring the expertise of an adequately trained and skilled physician. As the performance of interventional pain procedures is a necessary and integral part of the practice of Pain Medicine, it is the position of the AAPM that interventional pain procedures, and surgeries, be performed by a physician with sufficient training and expertise for the performance of any given procedure, as are the standards in other interventional and surgical subspecialties in medicine.

RESOLVED, The practice of Pain Medicine is the practice of medicine by a physician. Anyone who practices Pain Medicine and is not a physician is out of their scope of practice and should be held accountable for adverse outcomes. Patients expect and deserve the best in medical care, and when their care entails the practice of Pain Medicine, that care should only be offered by licensed and properly trained physicians to ensure the health and safety of all patients.

Approved by the AAPM Executive Committee on September 6, 2017

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American Academy of Pain Medicine