chronic-pain-opioid-treatment-report-140929

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Table A. Summary of evidence (continued)Key Question OutcomeStrength ofEvidenceGradeConclusionVarious harms Insufficient No studiesb. How do harms vary depending on the doseof opioids used?Abuse, addiction LowOne retrospective cohort study found higherdoses of long-term opioid therapy associated withincreased risk of opioid abuse or dependencethan lower doses. Compared to no opioidprescription, the adjusted odds ratios were 15 (95percent CI 10 to 21) for 1-36 MED/day, 29 (95percent CI 20 to 41) for 36-120 MED/day, and122 (95 percent CI 73 to 205) for ≥120 MED/day.Overdose LowVersus 1 to 19 mg MED/day, 1 cohort study foundan adjusted HR for an overdose event of 1.44(95% CI 0.57 to 3.62) for 20 to 49 mg MED/daythat increased to 11.18 (95% CI 4.80 to 26.03) at>100 mg MED/day; 1 case-control study found anadjusted OR for an opioid-related death of 1.32(95% CI 0.94 to 1.84) for 20 to 49 mg MED/daythat increased to 2.88 (95% CI 1.79 to 4.63) at≥200 mg MED/dayFracture LowRisk of fracture increased from an adjusted HR of1.20 (95% CI 0.92 to 1.56) at 1 to
Table A. Summary of evidence (continued)Key Question Outcome3. Dosing strategiesa. In patients with chronic pain, what is thecomparative effectiveness of different methodsfor initiating and titrating opioids for outcomesrelated to pain, function, and quality of life; risksof overdose, addiction, abuse, or misuse; anddoses of opioids used?PainFunction, quality of life, outcomes related toabuseb. In patients with chronic pain, what is thecomparative effectiveness of short- versus longactingopioids on outcomes related to pain,function, and quality of life; risk of overdose,addiction, abuse, or misuse; and doses ofopioids used?Strength ofEvidenceGradeInsufficientInsufficientConclusionEvidence from three trials on effects of titrationwith immediate-release versus sustained-releaseopioids reported inconsistent results on outcomesrelated to pain and are difficult to interpret due toadditional differences between treatment arms indosing protocols (titrated vs. fixed dosing) anddoses of opioids usedNo studiesES-15
Page 1 and 2: Evidence Report/Technology Assessme
Page 4 and 5: PrefaceThe Agency for Healthcare Re
Page 6 and 7: Charles Inturrisi, Ph.D.Professor o
Page 8 and 9: Robert Jamison, Ph.D.Professor of A
Page 10 and 11: Conclusions. Evidence on long-term
Page 12 and 13: no opioid on: (1) opioid abuse, add
Page 14 and 15: References ........................
Page 16 and 17: The purpose of this report is to sy
Page 18 and 19: patient education, (3) urine drug s
Page 20 and 21: Each abstract was independently rev
Page 22 and 23: We rated the quality of each cohort
Page 24 and 25: ResultsOverviewThe search and selec
Page 26 and 27: Key Question 4. Risk Assessment and
Page 30 and 31: Table A. Summary of evidence (conti
Page 32 and 33: Table A. Summary of evidence (conti
Page 34 and 35: Evidence on the effectiveness of di
Page 36 and 37: ApplicabilityA number of issues cou
Page 38 and 39: the exception of buccal or intranas
Page 40: References1. International Associat
Page 43 and 44: outcome study of long-term opioid d
Page 45 and 46: patients? Pain Physician. 2006;9(1)
Page 47 and 48: American Academy of Pain Medicine,
Page 49 and 50: d. What is the comparative effectiv
Page 51 and 52: inclusion to English-language artic
Page 53 and 54: adequately reported and acceptable;
Page 55 and 56: eview comments will be made availab
Page 57 and 58: Key Question 1aIn patients with chr
Page 59 and 60: Key Question 2aIn patients with chr
Page 61 and 62: and F2). 49-58 All were rated fair-
Page 63 and 64: Table 1. Uncontrolled studies of lo
Page 65 and 66: Table 1. Uncontrolled studies of lo
Page 67 and 68: The annual overdose rate was 256 pe
Page 69 and 70: The SOE for the association between
Page 71 and 72: One fair-quality cross-sectional st
Page 73 and 74: 5300 controls who did not visit the
Page 75 and 76: Key Question 3cIn patients with chr
Page 77 and 78: Table 2. Head-to-head trials and ob
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Table 2. Head-to-head trials and ob
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withdrawal due to opioid misuse, bu
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Table 3. Trials of different strate
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Table 3. Trials of different strate
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• Two studies evaluated the Scree
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Table 4. Studies of risk assessment
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Detailed SynthesisThe APS review id
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Evidence on the effectiveness of di
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Table 6. Summary of evidence (conti
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Page 99 and 100:
Page 101 and 102:
The setting in which studies were c
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switching to other prescription opi
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States: Fact Sheet. Atlanta, GA: Ce
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overdose: a cohort study. Ann Inter
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placebo-controlled study. Clin Ther
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pain. Ann Intern Med. 2014;160(1):3
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Appendix A. Search StrategiesDataba
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19. 18 and (random$ or control$ or
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11. (urine adj7 (screen$ or test$ o
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3. (alfentanil or alphaprodine or b
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25. Risk Reduction Behavior/ or Ris
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KQ 4a-4c: Risk Prediction and Mitig
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"meperidine" OR "meptazinol" OR (MH
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PICOT Include ExcludeOutcomes • F
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Moore TM, Jones T, Browder JH, et a
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Banning A, Sjogren P, Kaiser F. Rea
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study. Pain. 2004;108(1-2):17-27. P
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Edlund MJ, Sullivan M, Steffick D,
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Gianutsos L, Safrenek S. Is there a
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China. Addiction. 2011;106(10):1801
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study. Compr Psychiatry. 1979;20(1)
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2009;10(4):531-43. PMID: 19243306.
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Mercadante S, Casuccio A, Tirelli W
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2003;107(3):486-92. PMID: 14506751.
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Quigley C. Hydromorphone for acute
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osteoarthritis-related pain: placeb
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2013;7(2):96-101. PMID: 23385449. E
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effect of maternal, postnatal, adol
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Vestergaard P, Rejnmark L, Mosekild
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Yulug B, Ozan E. Buprenorphine: a s
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Author, YearType of StudySettingDur
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Page 165 and 166:
Page 167 and 168:
Author,yearDunn,2010ScreenedEligibl
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Author,yearGomes,2011ScreenedEligib
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Author,yearLi, 2013Method For Asses
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Author,yearMethod For AssessingOutc
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Appendix Table E4. Observational St
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Author, YearKQLi, 2013 KQ2a Case-Co
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Appendix Table E5. Observational St
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0Appendix Table E6. Observational S
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Appendix Table E7. Trials of Differ
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Appendix Table E8a. Head-to-Head Tr
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AuthorYearStudydesignDurationWild 2
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Author,YearHartung,2007Type of Stud
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Author,YearKrebs,2011Type of Study,
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AuthorYearStudyDesignDurationRCT12
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Author yearAshburn, 2011Study Desig
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Author yearPortenoy, 2007Study Desi
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Author yearSimpson, 2007Study Desig
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Author yearStudy designDurationCowa
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Author YearRalphs, 1994StudyDesignD
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Author,Year Study DesignAkbik 2006
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Author,YearWebster2005Study DesignP
Page 209 and 210:
Appendix F. Quality Assessment Tabl
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Author,YearGomes,2011Gomes,2013KQKQ
Page 213 and 214:
Evaluatespopulationother than theon
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Key QuestionOutcomeStudy DesignNumb
Page 217 and 218:
Key QuestionOutcomeStudy DesignNumb
Page 219:
Key Question Outcome4. Risk assessm
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