Opioid pharmacotherapy for chronic non-cancer pain in the United States: A research guideline for developing an evidence-base Journal Article


Authors: Chapman, C. R.; Lipschitz, D. L.; Angst, M. S.; Chou, R.; Denisco, R. C.; Donaldson, G. W.; Fine, P. G.; Foley, K. M.; Gallagher, R. M.; Gilson, A. M.; Haddox, J. D.; Horn, S. D.; Inturrisi, C. E.; Jick, S. S.; Lipman, A. G.; Loeser, J. D.; Noble, M.; Porter, L.; Rowbotham, M. C.; Schoelles, K. M.; Turk, D. C.; Volinn, E.; Von Korff, M. R.; Webster, L. R.; Weisner, C. M.
Article Title: Opioid pharmacotherapy for chronic non-cancer pain in the United States: A research guideline for developing an evidence-base
Abstract: 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. 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. © 2010 by the American Pain Society.
Keywords: treatment outcome; fracture; case-control studies; clinical trial; constipation; drug tolerability; review; drug efficacy; drug safety; drug withdrawal; nonhuman; risk benefit analysis; side effect; treatment duration; clinical trials as topic; united states; research design; evidence based medicine; evidence-based medicine; treatment indication; consensus; infection; pain; cohort studies; nausea; vomiting; opiate; incidence; sedation; randomized controlled trials as topic; practice guideline; growth hormone deficiency; chronic disease; health care policy; prescription; depression; pethidine; longitudinal studies; quantitative analysis; models, statistical; paracetamol; cardiotoxicity; medical research; diabetes mellitus; comorbidity; practice guidelines as topic; research; long term care; patient compliance; xerostomia; cognitive defect; chronic pain; osteoporosis; methadone; morphine; drug abuse; heart arrhythmia; analgesics, opioid; effectiveness; immune deficiency; anticonvulsive agent; drug treatment failure; databases, factual; hydromorphone; abdominal cramp; psychotropic agent; drug tolerance; socioeconomics; endocrine disease; infection sensitivity; periodontal disease; hyperalgesia; fentanyl; levorphanol; oxycodone; drug misuse; low back pain; opiate addiction; tricyclic antidepressant agent; efficacy; drug overdose; guideline; opioid pharmacotherapy; codeine; hydrocodone; hydrocodone bitartrate plus paracetamol; omega conotoxin mviia; oxymorphone; bloating; cross tolerance; dental caries; falling; intestine function disorder; lung tuberculosis; psychosocial environment; sleep disordered breathing; sudden death; united states department of veterans affairs
Journal Title: Journal of Pain
Volume: 11
Issue: 9
ISSN: 1526-5900
Publisher: Churchill Livingstone  
Date Published: 2010-09-01
Start Page: 807
End Page: 829
Language: English
DOI: 10.1016/j.jpain.2010.02.019
PUBMED: 20430701
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 13" - "Export Date: 20 April 2011" - "CODEN: JPOAB" - "Source: Scopus"
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  1. Kathleen M Foley
    121 Foley