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

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
Appendix G: Evidence Table
#
Recommendation
1. a) We recommend against initiation of long-term opioid
therapy for chronic pain.
b) We recommend alternatives to opioid therapy such as
self-management strategies and other nonpharmacological
treatments.
c) When pharmacologic therapies are used, we
recommend non-opioids over opioids.
2. If prescribing opioid therapy for patients with chronic pain,
we recommend a short duration.
Note: Consideration of opioid therapy beyond 90 days
requires re-evaluation and discussion with patient of risks
and benefits.
2010
Grade 14 Evidence 15 Strength of
Recommendation 16
None [80-83,85]
a) Strong against
None Additional References:
None [3][26,257]
b) Strong for
None [86-89,255]
Additional References:
[132]
c) Strong for
Strong for
Recommendation
Category 17
Reviewed, Newreplaced
Reviewed, Newreplaced
14 The 2010 VA/DoD OT CPG used the USPSTF evidence grading system (http://www.uspreventiveservicestaskforce.org). Inclusion of more than one 2010 Grade indicates that more
than one 2010 CPG recommendation is covered under the 2016 recommendation. The strength of recommendations were rated as follows: A- a strong recommendation that the
clinicians provide the intervention to eligible patients; B- a recommendation that clinicians provide (the service) to eligible patients; C- no recommendation for or against the
routine provision of the intervention is made; D- recommendation is made against routinely providing the intervention; I- the conclusion is that the evidence is insufficient to
recommend for or against routinely providing the intervention. “None” indicates that the 2017 OT CPG recommendation replaced or amended a 2010 OT CPG recommendation
for which there was no grade. “N/A” indicates that the 2017 OT CPG recommendation was a new recommendation, and therefore does not have an associated 2010 Grade.
15 The evidence column indicates studies that support each recommendation. For new recommendations, developed by the 2016 guideline Work Group, the literature cited
corresponds directly to the 2016 evidence review. For recommendations that have been carried over from the 2010 VA/DoD OT CPG, slight modifications were made to the
language in order to better reflect the current evidence and/or the change in grading system used for assigning the strength of each recommendation (USPSTF to GRADE). For
these “modified” recommendations, the evidence column indicates “additional evidence,” which can refer to either 1) studies that support the recommendation and which were
identified through the 2016 evidence review, or 2) relevant studies that support the recommendation, but which were not systematically identified through a literature review.
16 Refer to the Grading Recommendations section for more information on how the strength of the recommendation was determined using GRADE methodology.
17 Refer to the Recommendation Categorization section for more information on the description of the categorization process and the definition of each category.
February 2017 Page 127 of 192