Journal Article

Opioid Therapy for Chronic Pain: Overview of the 2017 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline

Bilka, Brandon M, Rosenberg, Jack M, Wilson, Sara M, Spevak, Christopher

2018

Overview

Abstract Description The US Department of Veterans Affairs (VA) and US Department of Defense (DoD) revised the 2010 clinical practice guideline (CPG) for the management of opioid therapy for chronic pain, considering the specific needs of the VA and DoD and new evidence regarding prescribing opioid medication for non-end-of-life-related chronic pain. This paper summarizes the major recommendations and compares them with the US Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids. Patient Population This Opioid Therapy CPG was developed for VA-DoD service members, veterans, and their families. Methods The VA/DoD Evidence-Based Practice Work Group convened a VA/DoD guideline renewal development effort and conformed to the guidelines established by the VA/DoD Joint Executive Council (JEC) and VA/DoD Health Executive Council (HEC). The panel developed questions, searched and evaluated the literature, developed recommendations using GRADE methodology, and developed algorithms. Passage of the CARA Act by Congress compelled consideration and comparison with the CDC opioid therapy guideline mid-development. Results There were 18 recommendations made. This article focuses on guideline development and key recommendations with CDC comparisons taken from four major areas, including: initiation and continuation of opioids;type, dose, follow-up, and taper of opioids;risk mitigation;acute pain. Conclusions Guideline development and recommendations are presented. There was substantial overlap with the CDC opioid guideline. Additionally, there were items particularly relevant to the VA-DoD, including risk mitigation, suicide prevention, and preventing opioid use disorder in young patients. Our guideline highlights avoiding opioid therapy longer than 90 days as a critical juncture.

• Publisher: Oxford University Press
• Subject: Acute pain / Acute Pain - drug therapy / Algorithms / Analgesics, Opioid - adverse effects / Analgesics, Opioid - therapeutic use / Animals / Care and treatment / Chronic pain / Chronic Pain - complications / Chronic Pain - drug therapy / Clinical medicine / Clinical practice guidelines / Disease control / Drug addiction / Evidence-based medicine / Humans / Narcotics / Opioid abuse / Opioids / Pain / Practice Guidelines as Topic / Prescription writing / Suicide / Suicide - prevention & control / Suicide prevention / Suicides & suicide attempts / United States / United States Department of Veterans Affairs - standards / Veterans