Recommendation | SFETD 29 | EFIC 31 | CDC 30 |
First establish an assessment with a clear and documented diagnosis, a physical examination, a psychological assessment and finally a determination of the impact of pain in all aspects of the patient’s life | ✔ | ✔ | |
Failure of first line recommended treatment given at maximum tolerated dose | ✔ | ✔ | ✔ |
Global comprehensive care of the patient (psychological, social, professional and rehabilitative management) | ✔ | ✔ | |
Expected benefits of opioid treatment should outweigh the risk | ✔ | ||
In fibromyalgia expected benefits of opioids are unlikely to overbalance the risks | ✔ | ✔ | |
Establish therapeutic goals with the patient and anticipating with clear explanation, the adverse effects and potential inefficiency | ✔ | ✔ | ✔ |
Define for the patient the different modes of action of the prescribed treatments and the difference between prolonged release and immediate release forms | ✔ | ✔ | |
Symptomatic treatment for the most common adverse reactions (constipation, nausea/vomiting) should be systematically prescribed | ✔ | ✔ | |
Treatment should be initiated at low doses with progressive titration | ✔ | ✔ | ✔ |
There is no evidence in the literature to recommend one molecule over another | ✔ | ✔ | |
Avoid dose greater than (morphine milligram equivalents) | 150 | 90 | |
Avoid co-prescription of benzodiazepines | ✔ | ✔ | |
Regular reassessment (with regard to previously set goals of pain relief, and/or functional improvement, and/or quality of life improvement) | ✔ | ✔ | ✔ |
Evaluate risk factors for opioid-related harms | ✔ | ✔ | ✔ |
EFIC, European Federation of IASP Chapters; SFETD, French Society of Study and Treatment of Pain.