VA/DoD Clinical Practice Guideline: Opioid Therapy for Chronic Pain Patient Summary, VA/Dod Evidence Based Practice

VA/DoD Clinical Practice Guideline: Opioid Therapy for Chronic Pain Patient Summary, VA/Dod Evidence Based Practice
VA/DoD Clinical Practice Guideline: Opioid Therapy for Chronic Pain Patient Summary, VA/Dod Evidence Based Practice
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The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management.

This Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical relationships between various care options and health outcomes while rating both the quality of the evidence and the strength of the recommendation.

Table of Contents

I. Introduction

II. How to Use This Clinical Practice Guideline 

III. Recommendations

IV. Algorithm

A. Module A: Determination of Appropriateness for Opioid Therapy

B. Module B: Treatment with Opioid Therapy

C. Module C: Tapering or Discontinuation of Opioid Therapy

D. Module D: Patients Currently on Opioid Therapy 

V. Background

A. Opioid Epidemic

B. Paradigm Shift in Pain and Its Treatment 

C. Prioritizing Safe Opioid Prescribing Practices and Use

D. Taxonomy

E. Epidemiology and Impact 

F. Chronic Pain and Co-occurring Conditions 

G. Risk Factors for Adverse Outcomes of Opioid Therapy 

VI. About this Clinical Practice Guideline 

A. Scope of this Clinical Practice Guideline

B. Highlighted Features of this Clinical Practice Guideline

C. Methods

D. Implementation 

E. Summary of Patient Focus Group Methods and Findings 

F. Conflict of Interest 

G. Patient-centered Care  

H. Shared Decision Making

I. Stepped Care Model for Pain Management 

J. Transfer of Care 

K. Clinical Decision Support Tools.

VII. Guideline Work Group

VIII. Discussion of Recommendations

A. Initiation and Continuation of Opioids

B. Risk Mitigation

C. Type, Dose, Duration, Follow-up, and Taper of Opioids

D. Opioid Therapy for Acute Pain 

Appendix A: VA Signature Informed Consent 

Appendix B: Urine Drug Testing

A. Benefits of Urine Drug Testing

B. Types of Urine Drug Testing 

Appendix C: Diagnostic and Statistical Manual of Mental Disorders for Opioid Use Disorders

Appendix D: Drug Tables 

A. Short-acting, Orally Administered Opioids

B. Long-acting/Extended-release Opioids.

C. Morphine Milligram Equivalent Doses 

D. Methadone Dosing Guidance

Appendix E: Evidence Review Methodology 

A. Developing the Scope and Key Questions. 

B. Conducting the Systematic Review

C. Convening the Face-to-face Meeting

D. Grading Recommendations

E. Recommendation Categorization  

F. Drafting and Submitting the Final Clinical Practice Guideline

Appendix F: Patient Focus Group Methods and Findings

A. Methods

B. Patient Focus Group Findings 

Appendix G: Evidence Table

Appendix H: 2010 Recommendation Categorization Table

Appendix I: Participant List

Appendix J: Literature Review Search Terms and Strategy

A. Topic-specific Search Terms 

B. Search Strategies

Appendix K: Abbreviation List



Department of Veterans Affairs (VA) and Department of Defense health prac titioners, TRICARE Managed Care Support Contractors, veterans and their support families with health issues.

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Veterans Affairs Dept. and Defense Dept.
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  • Pain
  • Drug Abuse Prevention
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