title: Opioids for chronic non-cancer pain: a protocol for a systematic review of randomized controlled trials.
abstract: BACKGROUND
  Opioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using opioids in the treatment of CNCP and the risk of associated adverse events.
  
  
  METHODS
  Eligible trials will include those that randomly allocate patients with CNCP to treatment with any opioid or any non-opioid control group. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to evaluate confidence in the evidence on an outcome-by-outcome basis. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. To ensure interpretability of our results, we will present risk differences and measures of relative effect for all outcomes reported and these will be based on anchor-based minimally important clinical differences, when available. We will conduct a priori defined subgroup analyses consistent with current best practices.
  
  
  CONCLUSIONS
  Our review will evaluate both the effectiveness and the adverse events associated with opioid use for CNCP, evaluate confidence in the evidence using the GRADE approach, and prioritize patient-important outcomes with a focus on functional gains guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with CNCP and identify key areas for future research.
  
  
  BACKGROUND
  Our protocol is registered on PROSPERO (CRD42012003023), http://www.crd.york.ac.uk/PROSPERO.
authors: Department of Anesthesia, McMaster University, Hamilton, Canada. bussejw@mcmaster.ca
authors: Jason W
authors: JW
authors: Busse
authors: Stefan
authors: S
authors: Schandelmaier
authors: Mostafa
authors: M
authors: Kamaleldin
authors: Sandy
authors: S
authors: Hsu
authors: John J
authors: JJ
authors: Riva
authors: Per Olav
authors: PO
authors: Vandvik
authors: Ludwig
authors: L
authors: Tsoi
authors: Tommy
authors: T
authors: Lam
authors: Shanil
authors: S
authors: Ebrahim
authors: Bradley
authors: B
authors: Johnston
authors: Lori
authors: L
authors: Oliveri
authors: Luis
authors: L
authors: Montoya
authors: Regina
authors: R
authors: Kunz
authors: Anna
authors: A
authors: Malandrino
authors: Neera
authors: N
authors: Bhatnagar
authors: Sohail M
authors: SM
authors: Mulla
authors: Luciane C
authors: LC
authors: Lopes
authors: Charlene
authors: C
authors: Soobiah
authors: Anthony
authors: A
authors: Wong
authors: Norman
authors: N
authors: Buckley
authors: Daniel
authors: D
authors: Sessler
authors: Gordon H
authors: GH
authors: Guyatt
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D012107:Research Design; D000078202:Systematic Reviews as Topic
chemical_list: D000701:Analgesics, Opioid
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