COMMENTS AND RESPONSES

TO THE EDITOR: Nuckols and colleagues ’ systematic review and critical appraisal of guidelines for the use of opioids for chronic pain (1) is problematic in that it may not meet the criteria of evidence-based medicine and suffers from issues of professionalism. Nuckols and colleagues included guidelines that raise concerns about bias, specifically those from the American Pain Society and the American Academy of Pain Medicine (APS-AAPM) (2), which barely met in-clusion criteria because they were published in 2009 (that is, the literature search ended in October 2008, so these guidelines were 5 years old when this review was published). Evidence-based medicine is a dynamic subject that continues to transform as opioid use and abuse changes more rapidly. We posit that in the rapidly evolving world of opioid use and abuse, 5 years may be too long an inclusion time. The authors also have given these guidelines the highest score even though Chou and Huffman wer