Abstract
BackgroundOpioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using opioids in the treatment of CNCP and the risk of associated adverse events.Methods and designEligible trials will include those that randomly allocate patients with CNCP to treatment with any opioid or any non-opioid control group. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to evaluate confidence in the evidence on an outcome-by-outcome basis. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. To ensure interpretability of our results, we will present risk differences and measures of relative effect for all outcomes reported and these will be based on anchor-based minimally important clinical differences, when available. We will conduct a priori defined subgroup analyses consistent with current best practices.DiscussionOur review will evaluate both the effectiveness and the adverse events associated with opioid use for CNCP, evaluate confidence in the evidence using the GRADE approach, and prioritize patient-important outcomes with a focus on functional gains guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with CNCP and identify key areas for future research.Trial registrationOur protocol is registered on PROSPERO (CRD42012003023), http://www.crd.york.ac.uk/PROSPERO.
Highlights
Opioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP)
Our review will evaluate both the effectiveness and the adverse events associated with opioid use for CNCP, evaluate confidence in the evidence using the GRADE approach, and prioritize patient-important outcomes with a focus on functional gains guided by Initiative on Methods Measurement (IMMPACT) recommendations
Chronic non-cancer pain (CNCP) includes any painful condition that persists for ≥3 months that is not associated with a diagnosis of cancer
Summary
Protocol and registration Our protocol is registered on PROSPERO (CRD42012003023), http://www.crd.york.ac.uk/PROSPERO. The results of our proposed systematic review will be used to update the Canadian Guideline, following which we will call a meeting of the National Faculty, a Canada wide group of 30 individuals representing organizations committed to the effective knowledge translation of the Canadian Guideline for Use of Opioids in Chronic Non-Cancer Pain This meeting will establish working groups responsible for ensuring that the updated guideline is translated into practice, that appropriate teaching materials are created and disseminated, that legislative bodies are appropriately informed and that the impact of the guideline is evaluated
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