ABSTRACT
This chapter provides the reader an overview of some of the important practical and ethical issues pertaining to the development and implementation of clinical practice guidelines in general, and those that relate to chronic nonmalignant pain treatment in particular. The field of guideline development has exploded in the United States, Canada, and the United Kingdom since the early 1990s. In the United States, the Agency for Health Care Policy and Research was tasked with creating medical practice guidelines. A guideline development group, ideally composed of six to 15 members, refines the clinical question of interest and identifies and collects all of the relevant medical research evidence. The overly prescriptive language of some guidelines and the use of arbitrary numbers along with simplistic algorithms for appropriate medical action might be used as evidence against a clinician who used a thorough yet complex process of clinical judgment to make treatment decisions that seemed to be best for the particular patient.
