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

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
Appendix H: 2010 Recommendation Categorization Table
2010
Recommendation
Location 18 2010 Recommendation Text 19
Module
Section
Number
1 A 1 A trial of opioid therapy is indicated for a patient with chronic pain who meets all of the
following criteria:
a. Moderate to severe pain that has failed to adequately respond to indicated non-opioid
and non- drug therapeutic interventions
b. The potential benefits of opioid therapy are likely to outweigh the risks (i.e., no
absolute contraindications)
c. The patient is fully informed and consents to the therapy
d. Clear and measurable treatment goals are established
1 A 2 The ethical imperative is to provide the pain treatment with the best benefit-to-harm
profile for the individual patient.
1 B 1 A comprehensive patient assessment should be completed to identify clinical conditions
that may interfere with the appropriate and safe use of opioid therapy (OT).
The comprehensive assessment should include:
a. Medical History
• Age, Sex
• History of present illness, including a complete pain assessment (see Annotation C)
2010 Grade 20
2016
Recommendation (if
Category 21 applicable) 22
None Not reviewed,
Deleted
None Not reviewed,
Deleted
None Not reviewed,
Deleted
18 The first three columns indicate the location of each recommendation within the 2010 OT CPG.
19 The 2010 Recommendation Text column contains the wording of each recommendation from the 2010 OT CPG.
20 The 2010 VA/DoD OT CPG used the U.S. Preventive Services Task Force (USPSTF) evidence grading system. http://www.uspreventiveservicestaskforce.org 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.
21 The Category column indicates the way in which each 2010 OT CPG recommendation was updated.
22 For recommendations that were carried forward to the 2010 OT CPG, this column indicates the new recommendation(s) to which they correspond.
February 2017 Page 132 of 192