Opioid pharmacotherapy for chronic non-cancer pain in the United States

A research guideline for developing an evidence-base

C. Richard Chapman, David L. Lipschitz, Martin S. Angst, Roger Chou, Richard C. Denisco, Gary W. Donaldson, Perry G. Fine, Kathleen M. Foley, Rollin M. Gallagher, Aaron M. Gilson, J. David Haddox, Susan D. Horn, Charles E. Inturrisi, Susan S. Jick, Arthur G. Lipman, John D. Loeser, Meredith Noble, Linda Porter, Michael C. Rowbotham, Karen M. Schoelles & 5 others Dennis C. Turk, Ernest Volinn, Michael R. Von Korff, Lynn R. Webster, Constance M. Weisner

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

This document reports the consensus of an interdisciplinary panel of research and clinical experts charged with reviewing the use of opioids for chronic noncancer pain (CNCP) and formulating guidelines for future research. Prescribing opioids for chronic noncancer pain has recently escalated in the United States. Contrasting with increasing opioid use are: 1) The lack of evidence supporting long-term effectiveness; 2) Escalating misuse of prescription opioids including abuse and diversion; and 3) Uncertainty about the incidence and clinical salience of multiple, poorly characterized adverse drug events (ADEs) including endocrine dysfunction, immunosuppression and infectious disease, opioid-induced hyperalgesia and xerostomia, overdose, falls and fractures, and psychosocial complications. Chief among the limitations of current evidence are: 1) Sparse evidence on long-term opioid effectiveness in chronic pain patients due to the short-term time frame of clinical trials; 2) Insufficiently comprehensive outcome assessment; and 3) Incomplete identification and quantification of ADEs. The panel called for a strategic interdisciplinary approach to the problem domain in which basic scientists and clinicians cooperate to resolve urgent issues and generate a comprehensive evidence base. It offered 4 recommendations in 3 areas: 1) A research strategy for studying the effectiveness of long-term opioid pharmacotherapy; 2) Improvements in evidence-generation methodology; and 3) Potential research topics for generating new evidence. Perspective: Prescribing opioids for CNCP has outpaced the growth of scientific evidence bearing on the benefits and harms of these interventions. The need for a strong evidence base is urgent. This guideline offers a strategic approach to creating a comprehensive evidence base to guide safe and effective management of CNCP.

Original languageEnglish (US)
Pages (from-to)807-829
Number of pages23
JournalJournal of Pain
Volume11
Issue number9
DOIs
StatePublished - Sep 2010

Fingerprint

Opioid Analgesics
Guidelines
Drug Therapy
Pain
Chronic Pain
Research
Drug-Related Side Effects and Adverse Reactions
Endocrine System Diseases
Xerostomia
Hyperalgesia
Immunosuppression
Uncertainty
Prescriptions
Communicable Diseases
Consensus
Outcome Assessment (Health Care)
Clinical Trials
Incidence
Growth

Keywords

  • chronic pain
  • effectiveness
  • efficacy
  • evidence-based medicine
  • guideline
  • Opioid pharmacotherapy

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Neurology
  • Clinical Neurology

Cite this

Chapman, C. R., Lipschitz, D. L., Angst, M. S., Chou, R., Denisco, R. C., Donaldson, G. W., ... Weisner, C. M. (2010). Opioid pharmacotherapy for chronic non-cancer pain in the United States: A research guideline for developing an evidence-base. Journal of Pain, 11(9), 807-829. https://doi.org/10.1016/j.jpain.2010.02.019

Opioid pharmacotherapy for chronic non-cancer pain in the United States : A research guideline for developing an evidence-base. / Chapman, C. Richard; Lipschitz, David L.; Angst, Martin S.; Chou, Roger; Denisco, Richard C.; Donaldson, Gary W.; Fine, Perry G.; Foley, Kathleen M.; Gallagher, Rollin M.; Gilson, Aaron M.; Haddox, J. David; Horn, Susan D.; Inturrisi, Charles E.; Jick, Susan S.; Lipman, Arthur G.; Loeser, John D.; Noble, Meredith; Porter, Linda; Rowbotham, Michael C.; Schoelles, Karen M.; Turk, Dennis C.; Volinn, Ernest; Von Korff, Michael R.; Webster, Lynn R.; Weisner, Constance M.

In: Journal of Pain, Vol. 11, No. 9, 09.2010, p. 807-829.

Research output: Contribution to journalArticle

Chapman, CR, Lipschitz, DL, Angst, MS, Chou, R, Denisco, RC, Donaldson, GW, Fine, PG, Foley, KM, Gallagher, RM, Gilson, AM, Haddox, JD, Horn, SD, Inturrisi, CE, Jick, SS, Lipman, AG, Loeser, JD, Noble, M, Porter, L, Rowbotham, MC, Schoelles, KM, Turk, DC, Volinn, E, Von Korff, MR, Webster, LR & Weisner, CM 2010, 'Opioid pharmacotherapy for chronic non-cancer pain in the United States: A research guideline for developing an evidence-base', Journal of Pain, vol. 11, no. 9, pp. 807-829. https://doi.org/10.1016/j.jpain.2010.02.019
Chapman, C. Richard ; Lipschitz, David L. ; Angst, Martin S. ; Chou, Roger ; Denisco, Richard C. ; Donaldson, Gary W. ; Fine, Perry G. ; Foley, Kathleen M. ; Gallagher, Rollin M. ; Gilson, Aaron M. ; Haddox, J. David ; Horn, Susan D. ; Inturrisi, Charles E. ; Jick, Susan S. ; Lipman, Arthur G. ; Loeser, John D. ; Noble, Meredith ; Porter, Linda ; Rowbotham, Michael C. ; Schoelles, Karen M. ; Turk, Dennis C. ; Volinn, Ernest ; Von Korff, Michael R. ; Webster, Lynn R. ; Weisner, Constance M. / Opioid pharmacotherapy for chronic non-cancer pain in the United States : A research guideline for developing an evidence-base. In: Journal of Pain. 2010 ; Vol. 11, No. 9. pp. 807-829.
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