Opioid use in chronic noncancer pain: guidelines revisited

Stein, Christoph; Reinecke, Henriette; Sorgatz, Hardo

doi:10.1097/aco.0b013e32833c57a8

Cited by 56 publications

(45 citation statements)

References 21 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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“…7 Beyond it there are areas of our work for which evidence has yet to be translated into widespread practice: mobilisation is good for many musculoskeletal problems; 11,12 the pharmaceutical pain relief produced by opiates or nonsteroidal anti-inflammatories for up to 3 months is less than the relief produced by placebo and after 3 months is unproven; 13 it's unclear whether antipyretics in children with fever are beneficial or harmful; 14 and wart treatment is probably no more effective than time.…”

Section: Knowledgementioning

confidence: 99%

First do no harm: evidence sometimes shows the self-evident to be wrong

Treasure¹

2013

Br J Gen Pract

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“…Titration ends when: 1) optimal dose (effective and stable) is reached; 2) favorable results are not reached due to insufficient analgesia after increasing two or three doses; 3) there are intolerable adverse effects or other medical complications (undesired interactions, co-morbidities); 4) there are evidences of abuse or dependence. On the other hand, opioids should be discontinued when: 1) pain generating prescription is resolved; 2) patient does not respond to any drug even with opioid rotation; 3) high opioid doses were used and patient, even with partial pain relief, remains disabled; 4) there are aberrant behaviors (abusive use) and/or intolerable adverse effects 12 . Recommendations for withdrawal, based on specific evidences and guidelines, are conflicting.…”

Section: Opioids Titration and Withdrawalmentioning

confidence: 99%