Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base.
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.


CONCLUSIONS
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.
Chapman
C Richard
CR
Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, Utah, USA. crc20@utah.edu
Lipschitz
David L
DL
Angst
Martin S
MS
Chou
Roger
R
Denisco
Richard C
RC
Donaldson
Gary W
GW
Fine
Perry G
PG
Foley
Kathleen M
KM
Gallagher
Rollin M
RM
Gilson
Aaron M
AM
Haddox
J David
JD
Horn
Susan D
SD
Inturrisi
Charles E
CE
Jick
Susan S
SS
Lipman
Arthur G
AG
Loeser
John D
JD
Noble
Meredith
M
Porter
Linda
L
Rowbotham
Michael C
MC
Schoelles
Karen M
KM
Turk
Dennis C
DC
Volinn
Ernest
E
Von Korff
Michael R
MR
Webster
Lynn R
LR
Weisner
Constance M
CM
D006801:Humans; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D032921:Consensus; D016208:Databases, Factual; D004361:Drug Tolerance; D019317:Evidence-Based Medicine / Q000592:standards; D008137:Longitudinal Studies; D015233:Models, Statistical; D010146:Pain / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D012106:Research / Q000592:standards; D012107:Research Design; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
D000701:Analgesics, Opioid