Framing Opioid Prescribing Guidelines for Acute Pain Developing the Evidence (2020) / Chapter Skim
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1 Introduction
1 Introduction
Pages 13-22
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From page 13... ...
However, some acute pain caused by a medical condition or injury can require medical interventions, including nonpharmacologic and pharmacologic treatments for pain as well as treatments aimed at the underlying cause of pain. Opioids have long been prescribed to relieve acute pain; morphine and opium have been used for centuries (Collier, 2018)
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From page 14... ...
The committee recognizes that the treatment of acute pain with opioids is one of many contributing factors to the national opioid epidemic. Over the past several years, the opioid overdose epidemic has received national attention and numerous governmental and private organizations have sought to reduce the number of deaths, overdoses, and addictions related to the use of opioids.
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From page 15... ...
One risk is the development of persistent opioid use in opioid-naïve patients who start opioids for acute pain (Barnett et al., 2017; Bateman et al., 2016; Brummett et al., 2017; Delgado et al., 2018; Deyo et al., 2017; Harbaugh et al., 2018; Meisel et al., 2019; Shah et al., 2017; Sun et al., 2016)
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From page 16... ...
STANDARDIZING OPIOID PRESCRIBING PRACTICES The inappropriate variation in opioid prescribing for surgical and medical conditions and the fact that overprescribing is a factor in the continuing opioid epidemic suggest that some guidelines for acute pain management for these conditions would be beneficial for both prescribers and their patients. One approach to setting such standards would be to establish evidence-based prescribing guidelines for opioids for pain management.
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From page 17... ...
This list should be prioritized to identify those first which are deemed to have the greatest potential impact on public health; • Develop a framework for evaluating the evidence base underpinning clinical practice guidelines for opioid prescribing to create a threshold level of evidence to support guidelines and ensure consistency among guidelines; • Evaluate existing opioid prescribing guidelines for acute pain using this framework to identify specific indications for which prescribing guidelines are not sufficiently evidence based; and • Develop a prioritized research agenda, by specific medical procedure or condition (not to exceed 10 of each surgical procedure or medical condition) for which no opioid prescribing guidelines exist or for which more evidence is required to support existing guidelines, to enable the development and availability of comprehensive evidence-based opioid prescribing guidelines for acute pain.
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From page 18... ...
The committee conducted literature searches to identify current opioid prescribing practices and trends, existing opioid prescribing guidance, information on the use of opioids to treat acute pain for the priority medical and surgical indications it identified, and information on the prevalence and incidence of the selected medical and surgical indications. Literature searches focused on the retrieval and evaluation of evidence-based publications in referred journals with an emphasis on randomized controlled trials, clinical trials, and large observational and cohort studies as an evidence base for opioid prescribing.
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From page 19... ...
ORGANIZATION OF THE REPORT Chapter 2 of this report focuses on a conceptual model of opioid prescribing for acute pain management. The committee lays out the definition of and background concerning acute pain and examines many of the patient factors that affect acute pain presentation and treatment response, such as age and genetics.
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From page 20... ...
Finally, in Chapter 7, the committee summarizes its recommendations for developing or improving evidence-based CPGs for prescribing opioids for acute pain, including which research needs should be emphasized. Appendix A presents short biographical sketches of the committee members, Appendix B provides the committee's literature search strategies, and Appendix C contains the agendas for the committee's public sessions.
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From page 21... ...
2017. Opioid prescribing for the treatment of acute pain in children on hospital discharge.
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From page 22... ...
2019. Initial opioid prescriptions among U.S.
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