The American Society of Anesthesiologists has thrown its hat into throwing out that which is useless: They have listed their choices for the top five therapies or tests that are of questionable usefulness in the field of pain medicine, their contribution to the American Board of Internal Medicine Foundation’s quest to document the more unnecessary interventions in the different fields of medicine—otherwise known as the “Choosing Wisely” campaign.
The list, also endorsed by the American Pain Society, tells us this about chronic pain:
Avoid prescribing opioid pain medications as the first-line treatment for patients with chronic (non-cancer) pain. Instead, the initial treatment should involve behavioral and physical therapy; and if drugs must be used, consider non-opioid alternatives.
Prescribe opioid medications for the short-term—not the long-term-- when treating chronic pain; if long-term therapy with these drugs appears inevitable, then patients must be informed of the risks, including addiction. Sign an “opioid contract.” Prescribers of opioids must be vigilant in terms of monitoring patients for adverse events such as constipation.
Do not perform expensive imaging examinations for otherwise acute back pain, unless there are clear indications. Wait at least six weeks before you start asking for that MRI.
Avoid the use of intravenous sedation.
Avoid interventions that may be irreversible, such as peripheral nerve blocks using chemicals or radiofrequency ablation. These can be a whole other source of chronic pain, in addition to having the potential to cause weakness and numbness.
In other words, use your common sense, providers of chronic pain treatrment.