Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline |
| |
| Authors: | Roger Chou Jane C Ballantyne Gilbert J Fanciullo Perry G Fine Christine Miaskowski |
| |
| Institution: | 1. The Oregon Evidence-Based Practice Center, Department of Medicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon;2. Division of Pain Medicine, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts;3. Pain Management Center, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire;4. Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, Utah;1. Department of Medicine, Oregon Health & Science University, Portland, Oregon;2. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon;3. Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon;1. Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan;2. Department of Surgery, Oregon Health & Science University, Portland, Oregon;1. Departments of Medicine and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, and Pacific Northwest Evidence-based Practice Center, Portland, Oregon;2. Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York;3. School of Public Health, Department of Medicine, Yale School of Medicine, New Haven, Connecticut;4. UCLA School of Nursing, Los Angeles, California;6. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania;5. Cardiology Uniformed Services, University of the Health Sciences, Baltimore, Maryland;7. Department of Pharmacology, Weill Cornell Medical College, New York, New York;11. Center for Adolescent Substance Abuse Research, Children''s Hospital Boston, Boston, Massachusetts;12. Division of Nursing Research and Education, Department of Population Sciences, City of Hope National Medical Center, Duarte, California;8. School of Biomedical and Health Sciences, New Jersey Medical School, Rutgers University, Newark, New Jersey;10. Departments of Medicine and Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York;9. Departments of Gynecology and Maternal Fetal Medicine, University of Vermont, Burlington, Vermont;71. Department of Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire;112. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland;123. Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky College of Medicine, Lexington, Kentucky;84. Pediatric Pain Program, Mattel Children''s Hospital at UCLA, Los Angeles, California;1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington;2. Department of Anesthesiology and Pain Medicine, Roswell Park Cancer Institute and University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York;3. The Johns Hopkins University School of Medicine, Baltimore, Maryland;4. Physical Therapy and Rehabilitation Science Graduate Program, University of Iowa, Iowa City, Iowa;5. Department of Anesthesia, University of Iowa, Iowa;1. Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas;2. Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Biobehavioral Pediatric Pain Lab, Boston Children''s Hospital; and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts;3. Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan |
| |
| Abstract: | Chronic noncancer pain is common and use of opioids is increasing. Previously published guidelines on use of opioids for chronic noncancer pain have been based primarily on expert consensus due to lack of strong evidence. We conducted searches on Ovid MEDLINE and the Cochrane databases through July 2008 to identify studies that addressed one or more of 37 Key Questions that a multidisciplinary expert panel identified as important to be answered to generate evidence-based recommendations on the use of opioids for chronic noncancer pain. A total of 14 systematic reviews, 38 randomized trials not included in a previously published systematic review, and 13 other studies met inclusion criteria. Almost all of the randomized trials of opioids for chronic noncancer pain were short-term efficacy studies. Critical research gaps on use of opioids for chronic noncancer pain include: lack of effectiveness studies on long-term benefits and harms of opioids (including drug abuse, addiction, and diversion); insufficient evidence to draw strong conclusions about optimal approaches to risk stratification, monitoring, or initiation and titration of opioid therapy; and lack of evidence on the utility of informed consent and opioid management plans, the utility of opioid rotation, the benefits and harms specific to methadone or higher doses of opioids, and treatment of patients with chronic noncancer pain at higher risk for drug abuse or misuse.PerspectiveCurrently, clinical decisions regarding the use of opioids for chronic noncancer pain need to be made based on weak evidence. Research funding priorities need to be set to address these critical research needs if the care of patients with chronic noncancer pain is to improve. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
