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Nonpharmacologic and Pharmacologic Management of Acute Pain From Non–Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians.

The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP. Read the details.

Guidance for Reopening Pain Practices Amidst COVID-19

The COVID-19 pandemic has resulted in unprecedented challenges to healthcare in general and to pain management practices in particular. Chronic pain patients being one of the most vulnerable patient populations under normal circumstances, have been affected particularly hard during the pandemic when pain management practices were closed and most treatment modalities, including medical management, physical therapy, psychological interventions, and interventional procedures were not available. Additionally, loss of revenue from not rendering services put a tremendous financial strain on pain practices. 

As pain practices work to continue treating patients and reopen more widely during the ongoing COVID-19 pandemic, AAPM has established recommendations to guide pain providers. While local conditions vary quite a bit from region to region, recommendations can be tailored to individual practices and local regulations, as well as the current state of the pandemic in their region.

AAPM recently featured this guidance on reopening pain practices amidst COVID-19 during a live webinar originally presented on June 2, 2020. A recording of this webinar is now freely available as a CME course in the AAPM Education Center. Reopening topics covered by the expert faculty panel during the course include: 

  • Patient care in light of the ongoing pandemic
  • Safety measures when reopening a pain clinic in order to protect both healthcare workers and patients
  • Risk stratification of pain management procedures based on urgency vs. the increased risk of contracting COVID-19
  • The important role of telemedicine
  • The financial impact of the pandemic and available resources, and 
  • How to prevent the physicians burnout during pandemic and beyond.
The presenters also created a summary of the guidance that is available for download.
AAPM is regularly updating its COVID-19 practice resources and creating adding new content at painmed.org/coronavirus.

New Clinical Practice Guidelines on Management of Pain in Sickle Cell Disease Co-Authored by AAPM Board Member, Rob Hurley, MD PhD

AAPM Director-at-Large Robert W. Hurley, MD PhD co-authored new clinical practice guidelines on management of pain in sickle cell disease (SCD) published in the American Society of Hematology (ASH) journal, Blood Advances.

Pain is the most common complication of SCD and it significantly decreases daily quality of life. Severe pain is the leading cause of emergency department visits and hospitalizations for people with SCD. Individuals with pain from SCD often don’t get the care they need because comprehensive information about medications and therapies had not been readily available. This guideline address clinical challenges by providing the first evidence-based recommendations to help individuals with SCD and their providers make the most informed decisions for personalized care.

Read the guidelines.

2-Part On Demand Course Features Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain

AAPM contributed to a multispecialty, international working group that recently published consensus practice guidelines on interventions for lumbar facet joint pain in Regional Anesthesia & Pain Medicine (RAPM), the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA).

There are few conditions as controversial as lumbar facet blocks and radiofrequency ablation (RFA). Wide variation exists between views of pain medicine interventionalists and non-pain physicians on the effectiveness. Furthermore there is a lack of standards reflecting input from multiple pain organizations and other stakeholders for the use of lumbar facet block and RFA. The RAPM consensus practice guidelines are designed to guide clinical care, improve research quality, and assist payers with clinical practice pathways and authorization decisions. 

Authors of the guidelines presented a 2-part symposium on February 28 in National Harbor during AAPM 2020 that is now available as an demand course in the AAPM Education Center.

 Course learning objectives include:

  • Review and improve selection criteria for “diagnostic” facet blocks.
  • Assess how to maximize lesion size and its relationship to RF ablation success rate.
  • Identify the issues surrounding patient selection for clinical practice and clinical trials.

The following recorded presentations and faculty members are covered in the course:

  • Guideline Questions, Methodology and Patient Selection: How Many Blocks, Cutoff for a Positive Block, and Are Medial Branch or Intra-Articular Injections Better? —Steven P. Cohen, MD
  • Imaging and Facet Pain: Evidence for Pre-Block Imaging and Imaging for the Performance Facet Blocks — W. Michael Hooten, MD
  • What is the Evidence for Larger Lesions and Parallel Electrode Orientation? — David A. Provenzano, MD
  • What Volume(s) Should be Used for Medial Branch Blocks and Intra-Articular Injections? — Jee Youn Moon, MD PhD FIPP CIPS
  • Minimizing Complications with Lumbar Facet Blocks — Samer N. Narouze, MD PhD
  • Should Facet Block Patients Routinely Be Sedated? — Robert W. Hurley, MD PhD FASA
  • Differences Between Clinical Practice and Clinical Trials — Mark S. Wallace, MD
  • Should a Trial of Conservative Care Be Mandatory Before Facet Blocks? — David J. Kennedy, MD
  • Should Sensory and Motor Testing Be Used Before Radiofrequency Ablation? — Zirong Zhao, MD, PhD, FACP

​AAPM members receive free access to this 2-part course, and nonmembers can purchase it for $49. Get started by logging into your AAPM account, or by creating an account if you do not yet have one. Contact Member Services for assistance at [email protected] or 847-375-4731.

COVID-19 Pain Management Practice Guidelines Published in AAPM Journal

April 7, 2020, CHICAGO – The official journal of the American Academy of Pain Medicine (AAPM), Pain Medicine, has published a practice guidelines article titled “Pain Management Best Practices from Multispecialty Organizations during the COVID-19 Pandemic and Public Health Crises” to assist pain medicine providers, health care leaders, and regulatory bodies as they respond to the COVID-19 crisis.

Ensuring that persons experiencing pain have continued access to pain management services throughout this global pandemic is crucial. The Pain Medicine guidelines, which are supported by the medical societies and organizations listed below, addresses how pain medicine specialists can continue to offer vital pain care while also implementing strategies designed to keep themselves, their clinical staff members, and their patients safe.

“The need for providers and patients to responsibly address the COVID crisis must be balanced with the public health benefits inherent in the treatment of pain, as well as with the welfare of healthcare providers. Walking this ‘fine balance’ is critically important for pain specialists right now,” says AAPM President, Ajay Wasan, MD MSc, who co-authored the guidelines. “The purpose of this article is to offer guidance to help pain providers mitigate procedure risks, establish plans that protect clinicians and patients, implement telemedicine options, and triage procedures and clinical visits during the COVID-19 outbreak appropriately.”

Given the urgent need for this information to be publicly available as quickly as possible, the Pain Medicine guidelines article has been published and is freely accessible as an Accepted Manuscript. The Accepted Manuscript is the final draft author manuscript, as accepted for publication by the journal, including modifications based on referees’ suggestions but before it has undergone copyediting, typesetting, or proof correction. Within a few weeks, the Accepted Manuscript will be replaced by a corrected proof, known as the Version of Record. Neither the Accepted Manuscript nor the Version of Record may be hosted by any organization or journal other than Pain Medicine, but anyone is welcome to link to the guideline.

AAPM member and Director-at-Large Steven P. Cohen, MD spearheaded efforts to create this guideline and is its lead author. Dr. Cohen worked with representatives from the following associations to gather input and support for recommendations included in the article:

  • American Academy of Pain Medicine (AAPM)
  • American Academy of Physical Medicine and Rehabilitation (AAPMR)  
  • American Society of Anesthesiologists (ASA)
  • American Society of Regional Anesthesia and Pain Medicine (ASRA)
  • North American Neuromodulation Society (NANS)
  • Spine Intervention Society (SIS)
  • United States Military
  • Veteran Health Administration
  • World Institute of Pain (WIP)
A panel of guideline authors representing the multispecialty organizations that assisted in developing these recommendations will present a live webinar on Monday, April 13, 6-7:15 pm CT. This live CME activity is free, and registration is required by logging into an existing AAPM account or creating a new account. Learn more and register. A recording of the webinar will be available following the live event.

View a video conversation with two of the guidelines’ authors, ​Stephen P. Cohen, MD ​and ​Friedhelm Sandbrink, MD​. 

About AAPM

The American Academy of Pain Medicine is the premier medical association for pain physicians and their treatment teams with some 2,000 members. Now in its 37th year of service, the Academy’s mission is to advance and promote the full spectrum of multidisciplinary pain care, education, advocacy, and research to improve function and quality of life for people in pain. Information is available on the Academy’s website at painmed.org

New Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain

Consensus practice guidelines on interventions for lumbar facet joint pain are now available in Regional Anesthesia & Pain MedicineMany AAPM members contributed to these consensus guidelines, which were developed by an international, multisociety working group. Thanks to Robert Hurley, MD PhD and W. Michael Hooten, MD who represented the Academy.

Read the guidelines.

View all AAPM Clinical Guidelines.

AAPM Foundation Convenes Opioid Reduction Consensus Panel

Pain management experts and patient advocates met this past week to begin developing clear evidence-informed guidance for healthcare clinicians on the reduction or elimination of opioids, when appropriate, for those who are prescribed them chronically.

National concerns about opioid abuse and opioid-related harm have driven regulatory, legislative, payer, and pharmacy policies restricting opioid prescribing and, in many cases, calling for opioid discontinuation. State and national mandates to reduce opioid prescribing have, in turn, led to prescriber fears, opioid supply limitations, and abandoned patients. While most practitioners agree that there is a need to decrease opioid use, few feel they have a clear understanding of how to get there. Further, there remains a need for clear guidance on how to safely and appropriately discontinue opioid treatment in select patients currently taking opioids. The consensus guideline produced by this panel over the next year will be intended to provide that guidance to pain specialists and primary care providers as well as to educate patients, payors, regulators and educations about the intricacies of opioid reduction.

Learn more about this AAPM Foundation and the other important initiatives undertaken by the Foundation.

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American Academy of Pain Medicine