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.
Key words
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Article info
Publication history
Published online: April 29, 2010
Footnotes
Supported by a grant to the first author from the Milbank Foundation. A grant from The Mayday Fund supported the work necessary for this document.
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
