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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.

Authors :
Chapman CR
Lipschitz DL
Angst MS
Chou R
Denisco RC
Donaldson GW
Fine PG
Foley KM
Gallagher RM
Gilson AM
Haddox JD
Horn SD
Inturrisi CE
Jick SS
Lipman AG
Loeser JD
Noble M
Porter L
Rowbotham MC
Schoelles KM
Turk DC
Volinn E
Von Korff MR
Webster LR
Weisner CM
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.)

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