Clinical evidence review for the CDC guideline for prescribing opioids for chronic pain \u2013 United States, 2016

Appendix to: Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain\u2014United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1\u201349.Contextual evidence is complementary information that assists in translating the clinical research findings into recommendations. CDC conducted contextual evidence reviews on four topics to supplement the clinical evidence review findings:\u2022 Effectiveness of non-pharmacologic (e.g., cognitive behavioral therapy [CBT], exercise therapy, interventional treatments, multimodal pain treatment) and non-opioid pharmacologic treatments (e.g., acetaminophen, non-steroidal anti-inflammatory drugs [NSAIDs], antidepressants, anticonvulsants),including studies of any duration;\u2022 Benefits and harms of opioid therapy (including additional studies not included in the clinical evidence review, such as studies that were not restricted to patients with chronic pain, evaluated outcomes at any duration, performed ecological analyses, or used observational study designs other than cohort and case-cohort control studies) related to specific opioids, high dose therapy, co-prescription with other controlled substances, duration of use, special populations, and potential usefulness of risk stratification/mitigation approaches; in addition to effectiveness of treatments associated with addressing potential harms of opioid therapy (opioid use disorder);\u2022 Clinician and patient values and preferences related to opioids and medication risks, benefits, and use; and\u2022 Resource allocation including costs and economic efficiency of opioid therapy and risk mitigation strategies.CDC also reviewed clinical guidelines that were relevant to opioid prescribing and could complement the CDC recommendations in development (e.g., guidelines on nonpharmacologic and nonopioid pharmacologic treatments; guidelines with recommendations related to specific clinician actions such as urine drug testing or opioid tapering protocols).Key Question 1. Effectiveness and Comparative Effectiveness -- Key Question 2. Harms and Adverse Events -- Key Question 3. Dosing Strategies -- Key Question 4. Risk Assessment and Risk Mitigation Strategies -- Key Question 5. Effect of Opioid Therapy for Acute Pain on Long Term Use.2016627