Chronic pain guidelines now available online

ACOEM offers more than 200 recommendations

The American College of Occupational and Environmental Medicine (ACOEM) in Chicago has published new medical treatment guidelines for providing care to workers with chronic pain. The new guidelines represent the latest chapter in ACOEM's publication Occupational Medicine Practice Guidelines.

More than 200 recommendations for chronic pain are outlined in the new evidence-based guidelines, which were developed by a multi-disciplinary panel of experts and were reviewed by representatives of 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. The recommendations 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 Kurt T. Hegmann, MD, MPH, editor-in-chief.

Other highlights include:

  • an in-depth review of more than 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 such as magnets; skilled allied-health provided medical therapies such as acupuncture, manipulation/mobilization, and myofascial release; and electrical therapies such as percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS);
  • uses and limitations of injection therapies such as diagnostic and therapeutic facet joint injections, trigger/tender point injections, botulinum injections, and intrathecal drugs;
  • a discussion of spinal cord stimulation for complex regional pain syndrome (CRPS) and other painful conditions;
  • a detailed review of psychological services, such as 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.

An electronic version is available now. The chapter price is $49.95 for members and $59.95 for non-members. At press time, the print version was expected to be available in October in the Occupational Medicine Practice Guidelines, Second Edition, 2008 Revision. To order print or electronic copies or individual chapters, contact ACOEM at (847) 818-1800, or visit