Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non‐Cancer Pain: Implications for Pain Physicians

Mailis-Gagnon, Angela; Tunks, Eldon

doi:10.1155/2011/434298

Cited by 110 publications

(236 citation statements)

References 9 publications

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“…The scope of the majority of included CPGs focused on opioid prescription and congruently, the content of the CPGs is also focused on opioid prescription (Tables 1 and 5, Additional file 1). The focus on opioid prescription can be ascribed to the dramatic rise in the prescription of opioids, as a result of the increase in the prevalence of chronic pain and the increase in dosage and frequency of prescription [10,[27][28][29]. The risks associated with opioid use may have created a growing need for clinical guidance on decision-making for opioid prescription.…”

Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary health care: A systematic review

2016

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Background: Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings. Methods: A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015. CPGs meeting the inclusion criteria were appraised by three reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II. Results: Of the 1082 records identified, 34 were eligible, and 12 CPGs were included based on the inclusion and exclusion criteria. The methodological rigor of CPG development was highly variable, and the median domain score was 66%. The median score for stakeholder involvement was 64%. The lowest median score was obtained for the domain applicability (48%). There was inconsistent use of frameworks to aggregate the level of evidence and the strength of the recommendation in the included CPGs. The scope and content of the included CPGs focussed on opioid prescription. Conclusion: Numerous CPGs that are applicable for the primary healthcare of CMSP exists, varying in their scope and methodological quality. This study highlights specific elements to enhance the development and reporting of CPGs, which may play a role in the uptake of guidelines into clinical practice. These elements include enhanced reporting of methodological aspects, the use of frameworks to enhance decision making processes, the inclusion of patient preferences and values, and the consideration of factors influencing applicability of recommendations. Trial registration: PROSPERO CRD42015022098.

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Section: Discussionmentioning

confidence: 99%

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary health care: A systematic review

2016

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“…The objective of the treatment is to determine the opioid dose which improves function and/or decreases pain intensity in at least 30% 8 . So, opioids shall be titrated for patients who: 1) have never used these drugs and have to start treatment; 2) are being treated with weak or strong opioids and are presenting severe or intolerable adverse effects, or who need opioid rotation; 3) are no longer responding to weak opioids and require replacement by strong opioids; 4) are receiving strong opioids and require higher doses (due to increased pain intensity or to the development of tolerance) even when in association with adjuvant drugs; 5) are in severe distress and need fast and effective intervention due to previous and persistent undertreatment 9,10 . On the other hand, optimal opioid dose should be evaluated by the balance of three factors: a) effectiveness: 30% to 50% decrease in initial pain intensity or improvement of factors related to quality of life (level of activities at work or at home, dietary habits, level of autonomy, cognitive aspects, sleep quality; and level of social activities); b) plateau dose: when increasing dose does not improve analgesia.…”

Section: Opioids Titration and Withdrawalmentioning

confidence: 99%

Recomendações para uso de opioides no Brasil: parte I

Kraychete¹,

Siqueira²,

Garcia³

2013

Rev. dor

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“…However, little evidence exists regarding UDT use for various patient subgroups. 12 Guidelines vary in their recommendations, with two 9,13 recommending mandatory testing for all COT patients, one advising testing for patients at risk for substance use disorders (SUDs), 8 and two 8,14 commenting that screening low-risk populations increases false-positive results and is less costeffective. 11 Knowledge regarding the risk factors for aberrant results could help inform evidence-based recommendations regarding UDTs for COT monitoring.…”

Section: Introductionmentioning

confidence: 99%

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

et al. 2014

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BACKGROUND: Urine drug tests (UDTs) are recommended for patients on chronic opioid therapy (COT). Knowledge of the risk factors for aberrant UDT results could help optimize their use. OBJECTIVE: To identify primary care COT patient and opioid regimen characteristics associated with aberrant UDT results. DESIGN: Population-based observational. SAMPLE: 5,420 UDTs for Group Health integrated group practice COT patients. MEASURES: Group Health database measures of patient demographics, medical history, COT characteristics, and UDT results. RESULTS: Thirty percent of UDTs had aberrant results, including prescribed opioid non-detection (12.3 %), tetrahydrocannabinol (THC; 11.2 %), non-prescribed opioid (5.3 %), illicit drug (excluding THC; 0.6 %), nonprescribed benzodiazepine (1.7 %), and dilute (4.8 %). Adjusted odds ratios (95 % CI) of any aberrant result were higher for males than females CONCLUSIONS: In this primary care setting, results were aberrant for 30 % of UDTs of COT patients, largely because of prescribed opioid non-detection and THC. Aberrant results of almost all types were more likely among patients under the age of 45. Other risk factors varied across aberrancies, but commonly included current smoking and prior substance use disorder diagnosis.KEY WORDS: urine drug test; chronic opioid therapy; chronic pain; marijuana.

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Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non‐Cancer Pain: Implications for Pain Physicians

Cited by 110 publications

References 9 publications

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary health care: A systematic review

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary health care: A systematic review

Recomendações para uso de opioides no Brasil: parte I

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

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