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Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base.
Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base.
- Source :
-
The journal of pain [J Pain] 2010 Sep; Vol. 11 (9), pp. 807-29. Date of Electronic Publication: 2010 Apr 28. - Publication Year :
- 2010
-
Abstract
- Unlabelled: This document reports the consensus of an interdisciplinary panel of research and clinical experts charged with reviewing the use of opioids for chronic noncancer pain (CNCP) and formulating guidelines for future research. Prescribing opioids for chronic noncancer pain has recently escalated in the United States. Contrasting with increasing opioid use are: 1) The lack of evidence supporting long-term effectiveness; 2) Escalating misuse of prescription opioids including abuse and diversion; and 3) Uncertainty about the incidence and clinical salience of multiple, poorly characterized adverse drug events (ADEs) including endocrine dysfunction, immunosuppression and infectious disease, opioid-induced hyperalgesia and xerostomia, overdose, falls and fractures, and psychosocial complications. Chief among the limitations of current evidence are: 1) Sparse evidence on long-term opioid effectiveness in chronic pain patients due to the short-term time frame of clinical trials; 2) Insufficiently comprehensive outcome assessment; and 3) Incomplete identification and quantification of ADEs. The panel called for a strategic interdisciplinary approach to the problem domain in which basic scientists and clinicians cooperate to resolve urgent issues and generate a comprehensive evidence base. It offered 4 recommendations in 3 areas: 1) A research strategy for studying the effectiveness of long-term opioid pharmacotherapy; 2) Improvements in evidence-generation methodology; and 3) Potential research topics for generating new evidence.<br />Perspective: Prescribing opioids for CNCP has outpaced the growth of scientific evidence bearing on the benefits and harms of these interventions. The need for a strong evidence base is urgent. This guideline offers a strategic approach to creating a comprehensive evidence base to guide safe and effective management of CNCP.<br /> (Copyright 2010 American Pain Society. All rights reserved.)
- Subjects :
- Humans
Case-Control Studies
Chronic Disease
Clinical Trials as Topic
Cohort Studies
Consensus
Databases, Factual
Drug Tolerance
Longitudinal Studies
Models, Statistical
Randomized Controlled Trials as Topic
Research Design
Treatment Outcome
United States
United States Department of Veterans Affairs
Analgesics, Opioid adverse effects
Analgesics, Opioid therapeutic use
Evidence-Based Medicine standards
Pain drug therapy
Research standards
Subjects
Details
- Language :
- English
- ISSN :
- 1528-8447
- Volume :
- 11
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- The journal of pain
- Publication Type :
- Academic Journal
- Accession number :
- 20430701
- Full Text :
- https://doi.org/10.1016/j.jpain.2010.02.019