Published on: April 7, 2014
“Choosing Wisely” is a program initiated by the ABIM Foundation. On their request, the American Society of Anaesthesiologists (ASA) has issued its list of top five tests and therapies that had better be avoided in treatment of chronic non-cancer pain.
They are the following:
1. Don’t prescribe opioid analgesics as first-line therapy to treat chronic non-cancer pain.
2. 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.
3. Avoid imaging studies (MRI, CT or X-rays) for acute low back pain without specific indications.
4. Don’t use intravenous sedation for diagnostic and therapeutic nerve blocks, or joint injections as a default practice. (This recommendation does not apply to pediatric patients.)
5. Avoid irreversible interventions for non-cancer pain that carry significant costs and/or risks.
(Read the complete article “Five Things Physicians and Patients Should Question“.)
Each of them gives serious food for thought and should make us think twice or thrice before prescribing opioids in non-cancer pain, asking for imaging early in a low back pain, using intravenous sedation for therapeutic interventions, and performing irreversible interventions for non-cancer pain, where the cost or risk is considerable.

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