The NIH has released panel recommendations for research into long-term use of opioids for chronic pain after researchers conducted an extensive review of literature. The findings were published today in The Annals of Internal Medicine.
The panel wrote that no long-term studies of opioid use have been conducted and called for further research to better identify which patients may benefit from treatment, as well as which may be harmed. Studies should incorporate a wide range of data, including disease type, demographics, psychological, sociocultural, ecological and biological characterizations of patients with well-defined and accepted diagnoses of chronic pain and clear records of prescribing information, according to the panel.
Both nonfederal and federal agencies should be involved in funding and validating multidisciplinary pain interventions, which include cost-benefit analysis and potential barriers to dissemination, according to the report. Additionally, further research should include developing measurement tools to identify at-risk patients for use in clinical settings.
Federal and nonfederal agencies were further recommended to develop risk identification and mitigation strategies and quality improvements to implement evidence-based decision-making before integrating new strategies into clinical practice.
The panel also recommended that health systems and vendors of electronic health records incorporate decisions support for long-term pain management and to develop standards to combine data with other health records to better identify which patients may be harmed or benefit from long-term opioid use.
Researchers conducting studies on the effectiveness and harms of treatment are encouraged by the panel to develop alternate study designs in addition to randomized clinical trials.
“Most opioid trials do not extend beyond 6 weeks and are of limited relevance to long-term opioid use,” the authors wrote. “Furthermore, clinical decision making for long-term opioid therapy is complex and requires individualized benefit-risk assessments; opioid selection and dose initiation and titration strategies; integration of risk assessment and mitigation strategies; and consideration of alternative, non-opioid therapies.”
The recommendations come after researchers reviewed 4,209 opioid use-related studies between January 2008 and August 2014 gathered from Medline, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycInfo and other databases. – by Shirley Pulawski