The impact of chronic pain on opioid addiction treatment: a systematic review protocol.
BACKGROUND
The consequences of opioid relapse among patients being treated with opioid substitution treatment (OST) are serious and can result in abnormal cardiovascular function, overdose, and mortality. Chronic pain is a major risk factor for opioid relapse within the addiction treatment setting. There exist a number of opioid maintenance therapies including methadone, buprenorphine, naltrexone, and levomethadyl acetate (LAAM), of which the mediating effects of pain on treatment attrition, substance use behavior, and social functioning may differ across therapies. We aim to 1) evaluate the impact of pain on the treatment outcomes of addiction patients being managed with OST and 2) identify the most recently published opioid maintenance treatment guidelines from the United States, Canada, and the UK to determine how the evidence is being translated into clinical practice.


METHODS
The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. We will search www.


CONCLUSIONS
gov and the National Institute for Care and Excellence (NICE) databases to identify the most recently published OST guidelines. All screening and data extraction will be completed in duplicate. Provided the data are suitable, we will perform a multiple treatment comparison using Bayesian meta-analytic methods to produce summary statistics estimating the effect of chronic pain on all OSTs. Our primary outcome is substance use behavior, which includes opioid and non-opioid substance use. We will also evaluate secondary endpoints such as treatment retention, general physical health, intervention adherence, personal and social functioning, as well as psychiatric symptoms.


CONCLUSIONS
This review will capture the experience of treatment outcomes for a sub-population of opioid addiction patients and provide an opportunity to distinguish the best quality guidelines for OST. If chronic pain truly does result in negative consequences for opioid addiction patients, it is important we identify which OSTs are most appropriate for chronic pain patients as well as ensure the treatment guidelines incorporate this information.


BACKGROUND
PROSPERO CRD42014014015 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014014015#.VS1Qw1wkKGM.
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. dennisbb@mcmaster.ca.|Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. dennisbb@mcmaster.ca.
Brittany B
BB
Dennis
Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. baworm@mcmaster.ca.|McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. baworm@mcmaster.ca.
Monica
M
Bawor
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. paulj@mcmaster.ca.|Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. paulj@mcmaster.ca.
James
J
Paul
Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. mvarenbut@canatc.ca.
Michael
M
Varenbut
Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. jdaiter@canatc.ca.
Jeff
J
Daiter
Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. cplater@toxpro.ca.
Carolyn
C
Plater
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. pareg@mcmaster.ca.
Guillaume
G
Pare
Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. dmarsh@nosm.ca.|Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario, P3E 2C6, Canada. dmarsh@nosm.ca.
David C
DC
Marsh
Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario, L4E4L6, Canada. worster@mcmaster.ca.|Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, Ontario, L8L 2X2, Canada. worster@mcmaster.ca.
Andrew
A
Worster
Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. dipika.desai@phri.ca.|Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. dipika.desai@phri.ca.
Dipika
D
Desai
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. thabanl@mcmaster.ca.|Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. thabanl@mcmaster.ca.|St. Joseph's Healthcare Hamilton, Centre for Evaluation of Medicine, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. thabanl@mcmaster.ca.|Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. thabanl@mcmaster.ca.
Lehana
L
Thabane
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. samaanz@mcmaster.ca.|Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. samaanz@mcmaster.ca.|Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada. samaanz@mcmaster.ca.|Peter Boris Centre for Addictions Research, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada. samaanz@mcmaster.ca.
Zainab
Z
Samaan
D000701:Analgesics, Opioid / Q000009:adverse effects*; D059350:Chronic Pain / Q000150:complications; D002985:Clinical Protocols; D006801:Humans; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000628:therapy*; D012008:Recurrence; D012107:Research Design; D000078202:Systematic Reviews as Topic
D000701:Analgesics, Opioid