New List for Choosing Wisely: Pain Medicine Suggestions

American Society of Anesthesiologists lists five things patients and doctors should question about pain medicine

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) This week, the American Society of Anesthesiologists (ASA) released their Choosing Wisely list of recommendations for patients experiencing pain.

The list includes five evidence-based recommendations, including advice to avoid opioids as a first defense against chronic non-cancer pain and to avoid MRIs and X-rays for acute low back pain.

The Choosing Wisely campaign was established to promote conversations between patients and doctors about effective, evidence-based healthcare practices.

Numerous organizations have compiled lists of tests, procedures and treatments that doctors and patients should question.

"Talk to your doctor about tests and treatments that work for you."

The American Society of Anesthesiologists Committee on Pain Medicine was tasked with developing a Choosing Wisely list on pain medicine.

The committee members submitted recommendations for the list, then the committee voted on which ones would make the final five. This committee ensured that each recommendation was backed by supporting clinical evidence.

The final top five list was reviewed by the ASA Executive Committee and Administrative Council, and it has been endorsed by the American Pain Society.

The five recommendations are:

  • "Don't prescribe opioid analgesics as first-line therapy to treat chronic non-cancer pain." According to the committee, solutions like physical or behavioral therapy may be more effective and helpful for patients with chronic pain than prescription pain pills. The ASA said that non-medication therapies should be suggested prior to medications, and patients should first try non-opioids like NSAIDs (ibuprofen, for example), as opioids come with more side effects and risks.
  • "Don't prescribe opioid analgesics as long-term therapy to treat chronic non-cancer pain until the risks are considered and discussed with the patient." Because opioids have a high potential for addiction, the ASA advises doctors to be cautious about prescriptions and to periodically evaluate patients on opioids. Aside from addiction, opioid use can also cause constipation and hormonal imbalances, so follow-up visits with a doctor are necessary to identify and treat side effects. 
  • "Avoid imaging studies (MRI, CT or X-rays) for acute low back pain without specific indications." According to the ASA, most low back pain does not need imaging and could lead to unnecessary surgery. For people with a history of certain conditions like cancer, imaging may be necessary.
  • "Don't use intravenous sedation for diagnostic and therapeutic nerve blocks, or joint injections as a default practice." The committee advises using only local anesthetic for diagnostic tests. Sedation can be risky and can prevent doctors from assessing pain levels.
  • "Avoid irreversible interventions for non-cancer pain that carry significant costs and/or risks." Some interventions like peripheral radiofrequency ablation, in which radio waves are used to block nerves, risk weakness, numbness or increased pain. The ASA recommends avoiding those treatments unless they are absolutely necessary.

“As leaders in patient safety, physician anesthesiologists want the most effective tests and treatments for our patients and we want them to be used appropriately,” ASA President Jane C. K. Fitch, MD, said in a statement. “ASA has taken the lead in improving patient safety related to anesthesiology and pain medicine. This Choosing Wisely list can make a positive and significant impact on patient care and quality.”

Almost 100 health care groups have compiled Choosing Wisely lists, including the American Academy of Pediatrics, the American College of Cardiology and the American College of Surgeons.

Review Date: 
January 23, 2014
Last Updated:
January 24, 2014