VA/DoD CLINICAL PRACTICE GUIDELINE FOR OPIOID THERAPY FOR CHRONIC PAIN

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
Table E-3. Key Question Specific Comparators
Question
Comparators
1 Patients without a co-occurring medical or mental health condition on LOT
2 Comparison groups that vary by LOT dosage and length of opioid use, other factors
3
4
5
No OT (including placebo) or other pain management strategies
Other modalities:
• Non-opioid medications (e.g., non-steroidal including compounded topical preparations)
• Physical interventions (e.g., physical therapy, active/passive exercise, ultrasound stimulation,
chiropractic, osteopathic manipulation therapy)
• Behavioral/mental health interventions EXAMPLES:
• CBT
• Dialectical behavior therapy (DBT)
• Mindfulness
• Acceptance and commitment therapy (ACT)
• Complementary and alternative interventions EXAMPLES:
• Acupuncture
• Chiropractic interventions
No OT (including placebo) or other pain management strategies
Other modalities:
• Non-opioid medications (e.g., non-steroidal including compounded topical preparations)
• Physical interventions (e.g., physical therapy, active/passive exercise, ultrasound stimulation,
chiropractic, osteopathic manipulation therapy)
• Behavioral/ mental health interventions (e.g., CBT, ACT, mindfulness, DBT)
• Complementary and alternative interventions
Long-acting opioid drugs or combination short and long-acting drugs (See list)
Other route of administration/delivery alternatives
Non abuse-deterrent formulations
Other opioids
No use of buprenorphine
No use of methadone
6 Opioid therapy alone
7 No mitigation strategy or other mitigation strategy
8 No treatment for OUD or other treatment for OUD
9 Different tapering strategy or schedule
d. Outcomes
For the treatment and management questions (KQ 3–9), the following outcomes were of interest in the
systematic review:
• Pain relief
• Quality of life
• Cognitive/functional status
• Mortality
• Opioid abuse/misuse
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