chronic-pain-opioid-treatment-report-140929

Table 6. Summary of evidence (continued)Key Question OutcomePain, function, quality of life, outcomes relatedto abusef. In patients with chronic pain on long-termopioid therapy, what is the comparativeeffectiveness of dose escalation versus dosemaintenance or use of dose thresholds onoutcomes related to pain, function, and qualityof life?Pain, function, withdrawal due to opioid misuseg. In patients on long-term opioid therapy, whatis the comparative effectiveness of opioidrotation versus maintenance of current opioidtherapy on outcomes related to pain, function,and quality of life; and doses of opioids used?Pain, function, quality of life, outcomes relatedto abuseh. In patients on long-term opioid therapy, whatis the comparative effectiveness of differentstrategies for treating acute exacerbations ofchronic pain on outcomes related to pain,function, and quality of life?PainStrength ofEvidenceGradeInsufficientLowInsufficientModerateConclusionNo studiesNo difference between more liberal doseescalation versus maintenance of current dosesin pain, function, or risk of withdrawal due toopioid misuse, but there was limited separation inopioid doses between groups (52 vs. 40 mgMED/day at the end of the trial)No studiesTwo randomized trials found buccal fentanylmore effective than placebo for treating acuteexacerbations of pain and three randomized trialsfound buccal fentanyl or intranasal fentanyl moreeffective than oral opioids for treating acuteexacerbations of pain in patients on long-termopioid therapy, based on outcomes measured upto 2 hours after dosingAbuse and related outcomes Insufficient No studiesi. In patients on long-term opioid therapy, whatare the effects of decreasing opioid doses or oftapering off opioids versus continuation ofopioids on outcomes related to pain, function,quality of life, and withdrawal?Pain, functionj. In patients on long-term opioid therapy, whatis the comparative effectiveness of differenttapering protocols and strategies on measuresrelated to pain, function, quality of life,withdrawal symptoms, and likelihood of opioidcessation?Opioid abstinenceInsufficientInsufficientAbrupt cessation of morphine was associatedwith increased pain and decreased functioncompared to continuation of morphineNo clear differences between different methodsfor opioid discontinuation or tapering in likelihoodof opioid abstinence after 3 to 6 months53