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Summary
Pages 1-12

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From page 1...
... To address how evidence-based clinical practice guidelines (CPGs) for prescribing opioids for acute pain might help meet this challenge, the U.S.
From page 2...
... for which opioids are commonly prescribed and for which evidence-based clinical practice guidelines would thus help inform prescribing practices. This list should be prioritized to identify those first which are deemed to have the greatest potential impact on public health; • Develop a framework for evaluating the evidence base underpinning clinical practice guidelines for opioid prescribing to create a threshold level of evidence to support guidelines and ensure consistency among guidelines; • Evaluate existing opioid prescribing guidelines for acute pain using this framework to identify specific indications for which prescribing guidelines are not sufficiently evidence based; and • Develop a prioritized research agenda, by specific medical procedure or condition (not to exceed 10 of each surgical procedure or medical condition)
From page 3...
... for which no clinical guidelines exist or for which more evidence is required to support existing guidelines. The committee also conducted literature searches to identify current opioid prescribing practices and trends, existing opioid prescribing guidance, the use of opioids to treat acute pain for selected medical and surgical indications, information on the prevalence and incidence of those selected indications, and standards for CPGs.
From page 4...
... for assessing the available evidence on opioid prescribing for acute pain indications,
From page 5...
... identifying research needs, and facilitating the incorporation of new knowledge into clinical practice as it becomes available. Establishing a Guideline Development Group A guideline development group that includes experts and representatives of key stakeholders and health care providers as well as methodologists, epidemiologists, and statisticians will strengthen the rigor and applicability of evidence-based CPGs.
From page 6...
... OPIOID HEALTH PRESCRIBED INTERMEDIATE OUTCOMES OUTCOMES EVIDENCE EVIDENCE Intermediate outcomes: Patient and amount of opioid population health Patient presents used/unused, refill outcomes: with acute pain Opioid requests, opioid Long-term • Pain due to a specific prescribing EVIDENCE misuse, diversion, opioid use procedure or strategy • Function condition health costs, patterns of health care • Quality of life utilization • Work or school • Mortality/morbidity • Adverse effects FIGURE S-2  Analytic framework for prescribing opioids for acute pain. This figure shows the evidence linkages that are necessary to support the development of a clinical practice guideline for opioid prescribing.
From page 7...
... The committee makes the following recommendations regarding the development of a framework to evaluate evidence-based CPGs: Recommendation: Professional societies; health care organizations; local, regional, and na tional stakeholders; and other developers of evidence-based clinical practice guidelines (CPGs) for opioid prescribing for acute pain should use an analytic framework (e.g., Figure S-2)
From page 8...
... Such evaluations can be used to determine the strength of recommendations for an effective opioid prescribing strategy. CPGs consider all types of evidence to assess the linkages between specific opioid prescribing strategies and intermediate and health outcomes in patients with acute pain.
From page 9...
... These impacts include short- and long-term patient and population-level intermedi ate and health outcomes, particularly opioid misuse, opioid use disorder, and opioid overdoses and deaths. PRIORITIZING SURGICAL AND MEDICAL INDICATIONS FOR CLINICAL PRACTICE GUIDELINE DEVELOPMENT The National Academies committee was tasked with identifying and prioritizing up to 50 specific surgical procedures and medical conditions that are associated with acute pain and for which opioid analgesics are commonly prescribed and considered clinically necessary.
From page 10...
... EVALUATING SELECTED CLINICAL PRACTICE GUIDELINES The committee evaluated seven existing opioid prescribing guidelines for acute pain for selected indications against its analytic framework. It chose three surgical procedures and four medical conditions that have public health impacts, for which there were some type of available guidelines and some evidence regarding opioid prescribing, and that were different in scope and context.
From page 11...
... Recommendation: Developers of evidence-based clinical practice guidelines (CPGs) for an acute pain indication should address the appropriate use of opioids for the indication as well as the optimal opioid prescribing strategies.
From page 12...
... affect the need for opioids for acute pain as well as assessing their effects on the intermediate outcomes and health outcomes of opioid prescribing strategies. Recommendation: Researchers studying opioid prescribing for acute pain should address the evidence gaps in the following key priority areas: • outcomes of opioid prescribing strategies in key patient populations; • the impact of clinical setting on opioid prescribing strategies; and • the links between intermediate outcomes, such as the number of unused pills or long term opioid use, and health outcomes, such as pain, mortality, overdose, opioid use disorder, and function.


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