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

VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain
Zedler et al.
(2014) 1,2,3 [58]
Dunn et al.
(2010) 1 [133]
Bohnert et al.
(2011) 1,3 [59]
Bohnert et al.
(2011) 2,3 [59]
OR
(CI)
HR
(CI)
HR
(CI)
HR
(CI)
- 1
0.19
(0.05-0.68)
1
- 1
- 1
1.5
(1.1-1.9)
1.19
(0.40-3.60)
1.88
(1.33-2.67)
1.74
(0.69-4.35)
2.2
(1.5-3.2)
3.11
(1.01-9.51)
4.63
(3.18-6.74)
6.01
(2.29-15.78)
4.1
(2.6-6.5)
11.18
(4.80-26.03)
7.18
(4.85-10.65)
11.99
(4.42-32.56)
1 CNCP; 2 Chronic cancer pain; 3 Study conducted in U.S. Veterans
Abbreviations: AOR: adjusted odds ratio; CI: 95% confidence interval; HR: hazard ratio; MEDD: morphine equivalent
daily dose; OR: odds ratio
In a nested case-control study of U.S. Veterans (not included in our evidence review as it was published
after the end of the search date range), Bohnert et al. (2016) examined the association between
prescribed opioid dose as a continuous measure (in 10 mg MEDD increments) and overdose.[134]
Prescribed opioid dosage was a moderately good predictor of overdose death, but the study did not reveal
a specific dosage cut point or threshold above which risk of overdose increased dramatically. Lower
prescribed opioid dosages were associated with reduced risk for overdose, but risk was not completely
eliminated at lower doses; approximately 40% of overdoses were observed in patients who were
prescribed