ACOEM Publishes Chronic Pain Guidelines

The American College of Occupational and Environmental Medicine has published new medical treatment guidelines for providing care to workers with chronic pain. The guidelines are available online now; in September a print version will be available.

More than 200 recommendations for chronic pain are outlined in the new evidence-based guidelines, which ACOEM says were developed by a multi-disciplinary panel of national experts and reviewed by representatives of leading medical and health organizations. The recommendations focus on diagnostic and other testing and treatments for several chronic pain conditions, including complex regional pain syndrome (CRPS), neuropathic pain, trigger points/myofascial pain, chronic persistent pain, fibromyalgia, and chronic low back pain. An extensive volume of literature was used to develop the recommendations, which feature more than 1,500 references, including 546 randomized controlled trials.

"These guidelines were developed using ACOEM's published methodology, which incorporates the highest scientific standards for reviewing evidence-based literature, ensuring the most rigorous, reproducible, and transparent occupational health guidelines available," said Editor-in-Chief Kurt T. Hegmann, M.D., MPH. "Literally thousands of hours of review of the available scientific literature went into this process, yielding what we consider state-of-the-art medical guidelines."

Other highlights of the guidelines include:

  • An in-depth review of over 20 medications (prescription, over-the-counter, complementary and alternative) used to treat patients with chronic pain, including an extensive appendix on guidance for the use of opioids.
  • Detailed recommendations regarding the use of appliances (e.g., magnets), skilled allied-health provided medical therapies (e.g., acupuncture, manipulation/mobilization, myofascial release), electrical therapies (e.g., PENS, TENS).
  • Uses and limitations of injection therapies (e.g., diagnostic and therapeutic facet joint injections, trigger/tender point injections, botulinum injections, intrathecal drugs).
  • A discussion of spinal cord stimulation for CRPS and other painful conditions.
  • A detailed review of psychological services (e.g., evaluation and behavior therapy) and rehabilitation for delayed recovery, including biofeedback, work conditioning/work hardening/early intervention programs, and interdisciplinary pain rehabilitation programs.
  • A focus on functional restoration, including an active exercise program and behavioral program.

In addition to being available electronically, the guidelines also will be available in a new print edition of the Occupational Medicine Practice Guidelines 2nd Edition, 2008 Revision, which is currently in production. Orders are being accepted now for delivery in September of this volume, which includes guidelines on a variety of musculoskeletal conditions. Individual chapters from the print publication are also available at ACOEM's Web site.

ACOEM's online treatment guidelines are exclusively distributed by Reed Group. For more information, or to order UMK Professional or the ACOEM Guidelines Electronic version, visit www.reedgroup.com or call (866) 889-4449.

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