Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 64 Page 65 Page 6658 MSFocus Summer 2016 In April 2016, the Centers for Disease Control and Prevention published updated guidelines in the Journal of the American Medical Association regarding the use of opioid medications. These guidelines provide recommendations based on best available evidence, interpreted and informed by opinion. The goal of these guidelines is to provide recommendations to primary care clinicians regarding how to prescribe opioid medications to patients suffering from chronic pain. Please note that these guidelines do not apply to treatment of active cancer pain, palliative care, or end-of-life care. While these guidelines are not specific to all types of MS-related pain, they are applicable for many MS patients. According to Dr. Ben W. Thrower, director of the MS Institute at the Shepherd Center in Atlanta, “It is common for patients with multiple sclerosis to suffer from chronic pain conditions that require treatment with opioid medications.” Dr. Ben went on to explain that these chronic pain conditions may or may not be related to MS. There are 12 recommendations in the 2016 guidelines. The guidelines were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. This type of grading method is commonly used when organizations publish guidelines. • Recommendation 1: Nonpharmacological therapy and nonopioid pharmacologic therapy are generally preferred for chronic pain. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacological therapy, as appropriate. (Recommendation category, A; evidence type, 3) Understanding the 2016 CDC Guidelines Regarding the Use of Opioid Medications for the Treatment of Chronic Pain By Ellen Whipple, BS, Pharm.D. MSF Medical Advisor Recommendation Categories: define to whom the guideline applies (i.e., all patients or individual patients): • Category A – applies to all patients • Category B – individual decision-making is needed Evidence Types: define the strength of evidence used to make the recommendation. • There are 4 levels of evidence • Type 1 evidence is the strongest evidence; type 4 evidence is the weakest evidence.