The American Society of Anesthesiologists (ASA) has issued its list of top 5 tests and therapies that are of questionable usefulness in the field of pain medicine.
?Don't prescribe opioid analgesics as first-line therapy to treat chronic non-cancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before pharmacologic intervention. If drug therapy appears indicated, try non-opioid medication, such as NSAIDs, anticonvulsants, etc. before starting opioids.
?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. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient's responsibilities (e.g., urine drug testing) and the consequences of noncompliance with the agreement. Avoid/be cautious in co-prescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low testosterone or estrogen
.?Avoid imaging tests, such as MRI, computed tomography, or radiography, for acute low back pain without specific indications such as prolonged sciatica.
?Don't use IV sedation, such as propofol, midazolam, or ultra-short-acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This applies to adult patients only.)
?Avoid irreversible interventions for non-cancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation.
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