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APS Bulletin • Volume 19, Number 1, 2009
President’s Message
Charles E. Inturrisi, PhD
The APS Clinical Guidelines Program: How We Got Here and Where We’re Going
The APS Clinical Guidelines Program is a major educational initiative of our strategic plan to advance the appropriate management of pain. It began in 1994 when Ada Jacox, PhD RN, and then-APS president Jim Campbell, MD, proposed to the board that the development of a guidelines program was a natural evolution of the APS educational program. We had published the Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, a consensus guideline, since 1987, and our membership had the scientific expertise to develop evidence-based guidelines. With the board’s approval, seed money from Jansen Pharmaceuticals, and a successful fundraising campaign, which was dubbed the “Case for Giving,” the project was launched.
Our first guideline, the Guideline for the Management of Acute and Chronic Pain in Sickle Cell Disease, was published in August of 1999. Dr. Jacox continued to direct the guidelines program that included the development of three additional guidelines and patient-oriented collateral pieces for arthritis, cancer, and fibromyalgia until her retirement in 2004.
After a competitive process, Roger Chou, MD, was awarded the contract to serve as the APS Director of Clinical Guidelines Development. Dr. Chou is based at the Oregon Evidence-Based Practice Center at Oregon Health & Science University, one of 14 centers designated by the U.S. Agency for Healthcare Research and Quality. Under Dr. Chou’s leadership and with direction from the Clinical Practice Guidelines Committee, chaired with great dedication and expertise by Christine Miaskowksi, PhD RN, the Clinical Guidelines Program has evolved in a number of areas. Three major clinical practice guidelines (Low Back Pain for Primary Care, Opioids for Chronic Noncancer Pain, and Interventional and Surgical Therapies for Low Back Pain [May 2009]) have been completed.
An important aspect of these guideline efforts is that APS partnered with other professional societies and groups to develop them, including the American College of Physicians (the largest specialty society in the United States), the American Academy of Pain Medicine, and the Veterans Affairs/Department of Defense. These partnerships not only helped pool resources efficiently, they also brought increased visibility, consensus, and credibility to our leadership of the guideline development process. Another important aspect of these efforts is that all of the recent guidelines have been accepted for publication by peer-reviewed journals, including the Annals of Internal Medicine, The Journal of Pain, and Spine. The decision to submit the guidelines to peer-reviewed journals not only provides another independent review process, but is part of the APS goal to make the guidelines accessible to the widest possible audience of pain management practitioners. In addition, each of these efforts has brought increased recognition to APS and the Clinical Guidelines Program, as evidenced by the broad media coverage that has accompanied each recent guideline release.
The Clinical Guidelines Program will continue to follow the partnership model as it develops additional guidelines and updates current ones. Future partnerships are likely to include national and international collaborations. The Clinical Guidelines Program continues to refine and enhance its guideline development processes to keep them consistent with the state-of-the-art methodology. In addition to developing new guidelines, the Clinical Guidelines Program also will address the important process of updating previously issued guidelines and developing even more effective dissemination, educational, and implementation strategies.
The Clinical Guidelines Program is strongly supported by the APS Board and consistently is regarded by APS members as one of the most valued benefits of membership in APS. All of the guidelines can be found at www.ampainsoc.org under Publications.
I thank Catherine Underwood and Roger Chou for their historical insights.
