Reviews
7 January 2014

Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain

Publication: Annals of Internal Medicine
Volume 160, Number 1

Abstract

Background:

Deaths due to prescription opioid overdoses have increased dramatically. High-quality guidelines could help clinicians mitigate risks associated with opioid therapy.

Purpose:

To evaluate the quality and content of guidelines on the use of opioids for chronic pain.

Data Sources:

MEDLINE, National Guideline Clearinghouse, specialty society Web sites, and international guideline clearinghouses (searched in July 2013).

Study Selection:

Guidelines published between January 2007 and July 2013 addressing the use of opioids for chronic pain in adults were selected. Guidelines on specific settings, populations, and conditions were excluded.

Data Extraction:

Guidelines and associated systematic reviews were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument and A Measurement Tool to Assess Systematic Reviews (AMSTAR), respectively, and recommendations for mitigating opioid-related risks were compared.

Data Synthesis:

Thirteen guidelines met selection criteria. Overall AGREE II scores were 3.00 to 6.20 (on a scale of 1 to 7). The AMSTAR ratings were poor to fair for 10 guidelines. Two received high AGREE II and AMSTAR scores. Most guidelines recommend that clinicians avoid doses greater than 90 to 200 mg of morphine equivalents per day, have additional knowledge to prescribe methadone, recognize risks of fentanyl patches, titrate cautiously, and reduce doses by at least 25% to 50% when switching opioids. Guidelines also agree that opioid risk assessment tools, written treatment agreements, and urine drug testing can mitigate risks. Most recommendations are supported by observational data or expert consensus.

Limitation:

Exclusion of non–English-language guidelines and reliance on published information.

Conclusion:

Despite limited evidence and variable development methods, recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug–drug and drug–disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing. Future research should directly examine the effectiveness of opioid risk mitigation strategies.

Primary Funding Source:

California Department of Industrial Relations and California Commission on Health and Safety and Workers’ Compensation.

Get full access to this article

View all available purchase options and get full access to this article.

Supplemental Material

Supplement. Modified AMSTAR Instrument

References

1.
Warner MChen LHMakuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999–2006. NCHS Data Brief. 2009;:1-8. [PMID: 19796521]
2.
Pletcher MJKertesz SGKohn MAGonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299:70-8. [PMID: 18167408]
3.
Boudreau DVon Korff MRutter CMSaunders KRay GTSullivan MDet al. Trends in long-term opioid therapy for chronic non-cancer pain. Pharmacoepidemiol Drug Saf. 2009;18:1166-75. [PMID: 19718704]
4.
Franklin GMMai JTurner JSullivan MWickizer TFulton-Kehoe D. Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. Am J Ind Med. 2012;55:325-31. [PMID: 22213274]
5.
Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA. 1995;274:1874-80. [PMID: 7500539]
6.
The Joint Commission. Facts about Pain Management. Oakbrook Terrace, IL: The Joint Commission; 2012. Accessed at www.jointcommission.org/pain_management on 9 March 2012.
7.
Katz LYCox BJClara IPOleski JSacevich T. Substance abuse versus dependence and the structure of common mental disorders. Compr Psychiatry. 2011;52:638-43. [PMID: 21295775]
8.
Dembe AWickizer TSieck CPartridge JBalchick R. Opioid use and dosing in the workers' compensation setting. A comparative review and new data from Ohio. Am J Ind Med. 2012;55:313-24. [PMID: 22068830]
9.
Becker WCTobin DGFiellin DA. Nonmedical use of opioid analgesics obtained directly from physicians: prevalence and correlates. Arch Intern Med. 2011;171:1034-6. [PMID: 21670373]
10.
Murphy SLXu JKochanek KDDivision of Vital Statistics. Deaths: Preliminary Data for 2010. National Vital Statistics Reports. Hyattsville, MD: U.S. Department of Health and Human Services; 2012.
11.
Office of National Drug Control Policy. Prescription Drug Abuse. Washington, DC: The White House; 2012. Accessed at www.whitehouse.gov/ondcp/prescription-drug-abuse on 11 May 2013.
12.
Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Pr; 2011.
13.
Chou RFanciullo GJFine PGAdler JABallantyne JCDavies Pet alAmerican Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-30. [PMID: 19187889]
14.
Noble MTreadwell JRTregear SJCoates VHWiffen PJAkafomo Cet al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010;:CD006605. [PMID: 20091598]
15.
Campbell CIWeisner CLeresche LRay GTSaunders KSullivan MDet al. Age and gender trends in long-term opioid analgesic use for noncancer pain. Am J Public Health. 2010;100:2541-7. [PMID: 20724688]
16.
American Medical Association. National Medical Specialty Society Websites. Chicago: American Medical Assoc; 2012. Accessed at www.ama-assn.org/ama/pub/about-ama/our-people/the-federation-medicine/national-medical-specialty-society-websites.page on 12 April 2012.
17.
Washington State Department of Labor & Industries. Medical Treatment Guidelines. Tumwater, WA: Washington State Department of Labor & Industries; 2012. Accessed at www.lni.wa.gov/claimsins/providers/treatingpatients/treatguide on 12 August 2012.
18.
California Division of Workers' Compensation. Medical Treatment Schedule. Chronic Pain Medical Treatment Guidelines. Sacramento, CA: California Division of Workers' Compensation; 2009. Accessed at www.coa.org/Saturday/sat13stevenfeinbergmdhandout1.pdf on 24 August 2012.
19.
Colorado Division of Workers' Compensation. Chronic Pain Disorder Medical Treatment Guidelines. Denver: Colorado Division of Workers' Compensation; 2011. Accessed at www.colorado.gov/cs/Satellite?c=Page&childpagename=CDLE-WorkComp%2FCDLELayout&cid=1251634346702&pagename=CDLEWrapper on 1 August 2013.
20.
Guidelines International Network Web site. Accessed at www.g-i-n.net on 1 August 2013.
21.
National Institute for Health and Care Excellence Web site. Accessed at www.nice.org.uk on 1 August 2013.
22.
Canadian Medical Association. CMA Infobase Web site. Accessed at www.cma.ca/clinicalresources/practiceguidelines on 1 August 2013.
23.
Australian Government National Health and Medical Research Council. Clinical Practice Guidelines Portal Web site. Accessed at www.clinicalguidelines.gov.au on 1 August 2013.
24.
Australian Government National Health and Medical Research Council. Guidelines and Publication Search Web site. Accessed at www.nhmrc.gov.au/guidelines/publications on 1 August 2013.
25.
Scottish Intercollegiate Guidelines Network Web site. Accessed at www.sign.ac.uk/guidelines/published/index.html on 1 August 2013.
26.
New Zealand Ministry of Health. New Zealand Guidelines Group Web site. Accessed at www.health.govt.nz/about-ministry/ministry-health-websites/new-zealand-guidelines-group on 1 August 2013.
27.
Biblioteca de Guías de Práctica Clínica del Sistema Nacional de Salud (Library of Clinical Practice Guidelines from the National Health System) Web site. Accessed at www.guiasalud.es/web/guest/gpc-sns on 1 August 2013.
28.
Agency for Quality in Medicine. AQuMed Database Web site. Accessed at www.aezq.de/aezq/publications on 1 August 2013.
29.
National Disease Management Guidelines Programme. German Disease Management Guidelines. Berlin, Germany: National Disease Management Guidelines Programme; 2012. Accessed at www.versorgungsleitlinien.de/english/index_html on 1 August 2013.
30.
European Medicines Agency. Document Library. London: European Medicines Agency; 2013. Accessed at www.ema.europa.eu/ema/index.jsp?curl=pages/document_library/landing/document_library_search.jsp?= on 1 August 2013.
31.
British Columbia Ministry of Health. BCGuidelines Web site. Accessed at www.bcguidelines.ca/alphabetical.html on 1 August 2013.
32.
Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Pr; 2011.
33.
Shekelle PGOrtiz ERhodes SMorton SCEccles MPGrimshaw JMet al. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA. 2001;286:1461-7. [PMID: 11572738]
34.
Brouwers MCKho MEBrowman GPBurgers JSCluzeau FFeder Get alAGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ. 2010;182:839-42. [PMID: 20603348]
35.
Brouwers MCKho MEBrowman GPBurgers JSCluzeau FFeder Get alAGREE Next Steps Consortium. Development of the AGREE II, part 1: performance, usefulness and areas for improvement. CMAJ. 2010;182:1045-52. [PMID: 20513780]
36.
Brouwers MCKho MEBrowman GPBurgers JSCluzeau FFeder Get alAGREE Next Steps Consortium. Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ. 2010;182:472-8. [PMID: 20513779]
37.
Shea BJHamel CWells GABouter LMKristjansson EGrimshaw Jet al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62:1013-20. [PMID: 19230606]
38.
AGREE Enterprise Web site. Accessed at www.agreetrust.org on 22 May 2013.
39.
Nuckols TKDiamant ALPopescu IAnderson LChou R. Report to The California Department of Industrial Relations and The California Commission on Health and Safety and Workers' Compensation: Identifying Risky Opioid Prescribing Practices. Los Angeles: Univ of California, Los Angeles; 2012.
40.
British Pain Society. Opioids for Persistent Pain: Good Practice. London: British Pain Society; 2010. Accessed at www.britishpainsociety.org/book_opioid_main.pdf on 1 August 2013.
41.
Health Care Association of New Jersey. Pain Management Guideline. Hamilton, NJ: Health Care Assoc of New Jersey; 2006. Accessed at www.hcanj.org/docs/hcanjbp_painmgmt2.pdf on 1 August 2013.
42.
Ho KYChua NHGeorge JMYeo SNMain NBChoo CYet al. Evidence-based guidelines on the use of opioids in chronic non-cancer pain—a consensus statement by the Pain Association of Singapore Task Force. Ann Acad Med Singapore. 2013;42:138-52. [PMID: 23604503]
43.
Drug and Alcohol Services South Australia. Opioid Prescription in Chronic Pain Conditions. Guidelines for South Australian General Practitioners (GPs). Parkside, Australia: Drug and Alcohol Services South Australia; 2008. Accessed at www.dassa.sa.gov.au/webdata/resources/files/Opioid_prescription_chronic_pain_guidelines_for_SA_GPs.pdf on 1 August 2013.
44.
Berland DW, Rodgers PE. Managing Chronic Non-Terminal Pain in Adults, Including Prescribing Controlled Substances. Ann Arbor, MI: Univ of Michigan Health System; 2012. Accessed at www.med.umich.edu/1info/FHP/practiceguides/pain/pain.pdf on 14 April 2012.
45.
Department of Veterans Affairs, Department of Defense. Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. Washington, DC: Department of Defense; 2012. Accessed at www.healthquality.va.gov/cot/cot_310_sum.pdf on 14 April 2012.
46.
Furlan ADReardon RWeppler CNational Opioid Use Guideline Group. Opioids for chronic noncancer pain: a new Canadian practice guideline. CMAJ. 2010;182:923-30. [PMID: 20439443]
47.
Institute for Clinical Systems Improvement. Assessment and Management of Chronic Pain. Bloomington, MN: Institute for Clinical Systems Improvement; 2011. Accessed at www.icsi.org/_asset/bw798b/ChronicPain.pdf on 14 April 2012.
48.
Rolfs RTJohnson EWilliams NJSundwall DNUtah Department of Health. Utah clinical guidelines on prescribing opioids for treatment of pain. J Pain Palliat Care Pharmacother. 2010;24:219-35. [PMID: 20718642]
49.
Manchikanti LAbdi SAtluri SBalog CCBenyamin RMBoswell MVet alAmerican Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part 2—guidance. Pain Physician. 2012;15:S67-116. [PMID: 22786449]
50.
Utah Department of Health. Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain. Salt Lake City, UT: Utah Department of Health; 2009.
51.
AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50:S205-24. [PMID: 12067390]
52.
American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57:1331-46. [PMID: 19573219]
53.
American Society of Anesthesiologists Task Force on Chronic Pain Management. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112:810-33. [PMID: 20124882]
54.
Fine PGPortenoy RKAd Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. Establishing “best practices” for opioid rotation: conclusions of an expert panel. J Pain Symptom Manage. 2009;38:418-25. [PMID: 19735902]
55.
American College of Occupational and Environmental Medicine. ACOEM Guidelines for Chronic Use of Opioids. Elk Grove Village, IL: American Coll of Occupational and Environmental Medicine; 2008. Accessed at www.acoem.org/Guidelines_Opioids.aspx on 13 March 2012.
56.
Work Loss Data Institute. Pain (chronic). Encinitas, CA: Work Loss Data Institute; 2011.
57.
American Pain Society, American Academy of Pain Medicine. Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain: Evidence Review. Chicago: American Pain Soc; 2009. Accessed at www.americanpainsociety.org/uploads/pdfs/Opioid_Final_Evidence_Report.pdf on 30 April 2013.
58.
Chou R. 2009 Clinical guidelines from the American Pain Society and the American Academy of Pain Medicine on the use of chronic opioid therapy in chronic noncancer pain: what are the key messages for clinical practice? Pol Arch Med Wewn. 2009;119:469-77. [PMID: 19776687]
59.
Manchikanti LAbdi SAtluri SBalog CCBenyamin RMBoswell MVet alAmerican Society of Interventional Pain Physicians. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I—evidence assessment. Pain Physician. 2012;15:S1-65. [PMID: 22786448]
60.
National Opioid Use Guideline Group. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Hamilton, Ontario, Canada: National Pain Centre; 2010. Accessed at http://nationalpaincentre.mcmaster.ca/opioid on 13 April 2012.
61.
Kahan MMailis-Gagnon AWilson LSrivastava ANational Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population. Can Fam Physician. 2011;57:1257-66, e407-18. [PMID: 22084455]
62.
Kahan MWilson LMailis-Gagnon ASrivastava ANational Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations. Can Fam Physician. 2011;57:1269-76, e419-28. [PMID: 22084456]
63.
U.S. Food and Drug Administration. FDA Public Health Advisory: Important Information for the Safe Use of Fentanyl Transdermal System (Patch). Silver Spring, MD: U.S. Food and Drug Administration; 2007. Accessed at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm051257.htm on 27 April 2013.
64.
Butler SFBudman SHFernandez KJamison RN. Validation of a screener and opioid assessment measure for patients with chronic pain. Pain. 2004;112:65-75. [PMID: 15494186]
65.
Butler SFFernandez KBenoit CBudman SHJamison RN. Validation of the revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R). J Pain. 2008;9:360-72. [PMID: 18203666]
66.
Passik SDKirsh KL. An opioid screening instrument: long-term evaluation of the utility of the pain medication questionnaire by Holmes et al [Editorial]. Pain Pract. 2006;6:69-71. [PMID: 17309712]
67.
Passik SDKirsh KLWhitcomb LPortenoy RKKatz NPKleinman Let al. A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004;26:552-61. [PMID: 15189752]
68.
Butler SFBudman SHFernandez KCHoule BBenoit CKatz Net al. Development and validation of the Current Opioid Misuse Measure. Pain. 2007;130:144-56. [PMID: 17493754]
69.
Centers for Disease Control and Prevention (CDC). CDC grand rounds: prescription drug overdoses—a U.S. epidemic. MMWR Morb Mortal Wkly Rep. 2012;61:10-3. [PMID: 22237030]
70.
Harris SRSchmitz KHCampbell KLMcNeely ML. Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals. Cancer. 2012;118:2312-24. [PMID: 22488705]
71.
Loder EBurch RRizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012;52:930-45. [PMID: 22671714]
72.
Burda BUNorris SLHolmer HKOgden LASmith ME. Quality varies across clinical practice guidelines for mammography screening in women aged 40-49 years as assessed by AGREE and AMSTAR instruments. J Clin Epidemiol. 2011;64:968-76. [PMID: 21420280]
73.
Cabana MDRand CSPowe NRWu AWWilson MHAbboud PAet al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458-65. [PMID: 10535437]
74.
Chan W. Implementation of GLIA assessment in Kaiser Permanente and NHLBI to improve implementability of recommendations. Otolaryngol Head Neck Surg. 2010;143:59.1.
75.
Gupta SBhattacharyya OKBrouwers MCEstey EAHarrison MBHernandez Pet al. Canadian Thoracic Society: Presenting a new process for clinical practice guideline production. Can Respir J. 2009;16:62-8. [PMID: 20011719]
76.
van Dijk LJNelen WLD'Hooghe TMDunselman GAHermens RPBergh Cet al. The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal. Implement Sci. 2011;6:7. [PMID: 21247418]
77.
GuideLine Implementability Appraisal Web site. Accessed at http://nutmeg.med.yale.edu/glia/login.htm;jsessionid=C839F08F4060F49D3F86DF9D7A749BA on 6 September 2012.
78.
Bohnert ASValenstein MBair MJGanoczy DMcCarthy JFIlgen MAet al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305:1315-21. [PMID: 21467284]
79.
Dunn KMSaunders KWRutter CMBanta-Green CJMerrill JOSullivan MDet al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152:85-92. [PMID: 20083827]
80.
Gomes TMamdani MMDhalla IAPaterson JMJuurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171:686-91. [PMID: 21482846]
81.
Furlan ADSandoval JAMailis-Gagnon ATunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174:1589-94. [PMID: 16717269]
82.
Kalso EEdwards JEMoore RAMcQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain. 2004;112:372-80. [PMID: 15561393]
83.
Papaleontiou MHenderson CR JrTurner BJMoore AAOlkhovskaya YAmanfo Let al. Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2010;58:1353-69. [PMID: 20533971]
84.
Manchikanti LAilinani HKoyyalagunta DDatta SSingh VEriator Iet al. A systematic review of randomized trials of long-term opioid management for chronic non-cancer pain. Pain Physician. 2011;14:91-121. [PMID: 21412367]
85.
Noble MTregear SJTreadwell JRSchoelles K. Long-term opioid therapy for chronic noncancer pain: a systematic review and meta-analysis of efficacy and safety. J Pain Symptom Manage. 2008;35:214-28. [PMID: 18178367]
86.
Fishbain DACole BLewis JRosomoff HLRosomoff RS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008;9:444-59. [PMID: 18489635]
87.
Washington State Agency Medical Directors' Group. Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain: An Educational Aid to Improve Care and Safety With Opioid Therapy. Olympia, WA: Washington State Agency Medical Directors' Group; 2010. Accessed at www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf on 14 April 2012.
88.
Nuckols TKLim YWWynn BOMattke SMacLean CHHarber Pet al. Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers. J Gen Intern Med. 2008;23:37-44. [PMID: 18030541]

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 160Number 17 January 2014
Pages: 38 - 47

History

Published online: 7 January 2014
Published in issue: 7 January 2014

Keywords

Authors

Affiliations

Teryl K. Nuckols, MD, MSHS
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Laura Anderson, MPH
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Ioana Popescu, MD, MPH
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Allison L. Diamant, MD, MSHS
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Brian Doyle, MD
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Paul Di Capua, MD
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Roger Chou, MD
From David Geffen School of Medicine at University of California, Los Angeles, and UCLA Fielding School of Public Health, Los Angeles, California; RAND Corporation, Santa Monica, California; and Oregon Health & Science University, Portland, Oregon.
Financial Support: By the California Department of Industrial Relations and the California Commission on Health and Safety and Workers’ Compensation. Dr. Nuckols was supported by a Mentored Clinical Scientist Career Development Award (K08) from the Agency for Healthcare Research and Quality (grant HS17954).
Disclosures: Dr. Nuckols: Other: California Commission on Health and Safety and Worker's Compensation, Collaborative Spine Research Foundation. Dr. Chou: Grant: California Commission on Health and Safety and Worker's Compensation, American Pain Society. All other authors have no disclosures. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1193.
Corresponding Author: Teryl K. Nuckols, MD, MSHS, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90095; e-mail, [email protected].
Current Author Addresses: Drs. Nuckols, Popescu, Diamant, Doyle, and Di Capua: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90095.
Ms. Anderson: UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, 16-035 Center for Health Sciences, Los Angeles, CA 90095-1772.
Dr. Chou: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098.
Author Contributions: Conception and design: T.K. Nuckols, A.L. Diamant, R. Chou.
Analysis and interpretation of the data: T.K. Nuckols, L. Anderson, I. Popescu, A.L. Diamant, B. Doyle, P. Di Capua, R. Chou.
Drafting of the article: T.K. Nuckols, I. Popescu, A.L. Diamant, R. Chou.
Critical revision of the article for important intellectual content: T.K. Nuckols, I. Popescu, A.L. Diamant, B. Doyle, R. Chou.
Final approval of the article: T.K. Nuckols, I. Popescu, A.L. Diamant, P. Di Capua, R. Chou.
Provision of study materials or patients: T.K. Nuckols.
Statistical expertise: T.K. Nuckols.
Obtaining of funding: T.K. Nuckols.
Administrative, technical, or logistic support: T.K. Nuckols, L. Anderson.
Collection and assembly of data: T.K. Nuckols, L. Anderson, I. Popescu, A.L. Diamant, B. Doyle, P. Di Capua.
This article was published online first at www.annals.org on 12 November 2013.

Metrics & Citations

Metrics

Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format





Download article citation data for:
Teryl K. Nuckols, Laura Anderson, Ioana Popescu, et al. Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain. Ann Intern Med.2014;160:38-47. [Epub 7 January 2014]. doi:10.7326/0003-4819-160-1-201401070-00732

View More

Get Access

Login Options:
Purchase

You will be redirected to acponline.org to sign-in to Annals to complete your purchase.

Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.

Create your Free Account

You will be redirected to acponline.org to create an account that will provide access to Annals.

View options

PDF/ePub

View PDF/ePub

Related in ACP Journals

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media