The Agency for Healthcare Research and Quality (AHRQ) has released three draft reports that are available for public comment. These reviews assess scientific evidence published since the release of the CDC Guideline for Prescribing Opioids for Chronic Pain in March 2016. Public comment may be submitted for these reports through November 12, 2019.
- Noninvasive Nonpharmacological Treatments for Chronic Pain: A Systematic Review Update updates the evidence from the AHRQ 2018 report, which assessed persistent improvement in outcomes following completion of therapy for noninvasive nonpharmacological treatment for selected chronic pain conditions.Public comment for this report may be submitted through this link.
- Opioid Treatments for Chronic Pain assesses the effectiveness and harms of opioid therapy for chronic noncancer pain; alternative opioid dosing strategies; and risk mitigation strategies. Public comment for this report may be submitted through this link.
- Nonopioid Pharmacologic Treatments for Chronic Pain evaluates the benefits and harms of nonopioid drugs in randomized controlled trials (RCTs) of patients with specific types of chronic pain, considering the effects on pain, function, quality of life, and adverse events. Public comment for this report may be submitted through this link.
If you have any questions, please go to AHRQ’s website at https://www.ahrq.gov/.
Below is a summary of the key findings from each of these reports. Please forward this announcement to others who may be interested in learning more about these AHRQ efforts or providing public comment.
AHRQ found that the following interventions improved function and/or pain for at least 1 month after treatment completion:
- Low back pain: exercise, psychological therapies (primarily cognitive behavioral therapy [CBT]), spinal manipulation, low level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR).
- Neck pain: exercise, low level laser, mind-body practices, massage, acupuncture.
- Knee osteoarthritis: exercise, CBT.
- Hip osteoarthritis: exercise, manual therapies.
- Fibromyalgia: exercise, CBT, myofascial release massage, tai chi, qigong, acupuncture, MDR.
- Tension headache: Spinal manipulation.
- Opioids are associated with small improvements versus placebo in pain and function and increased risk of harms at short-term (1 to <6 months) follow-up; evidence on long-term effectiveness is very limited and there is evidence of increased risk of serious harms that appear to be dose-dependent.
- At short-term follow up, the evidence showed no differences between opioids versus nonopioid medications in improvement in pain, function, mental health status, sleep, or depression.
- Evidence on the effectiveness and harms of alternative opioid dosing strategies and the effects of risk mitigation strategies is lacking, though provision of naloxone to patients might reduce the likelihood of opioid-related emergency department visits, a taper support intervention might improve functional outcomes compared to no taper support, and co-prescription of benzodiazepines and gabapentinoids might increase risk of overdose.
- No instrument has been shown to be associated with high accuracy for predicting opioid overdose, addiction, abuse, or misuse.
In the short term,
- The anticonvulsants pregabalin, gabapentin, and oxcarbazepine show small improvements in pain and function in patients with diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia.
- The serotonin-norepinephrine reuptake inhibitors (SNRI) antidepressants duloxetine and/or milnacipran show small to moderate improvements in pain, function, and quality of life in patients with diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia. Patients with low back pain had small improvements in pain and no improvement in function.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) show small improvements in pain and function in patients with osteoarthritis and inflammatory arthritis. Acetaminophen did not result in improvements in pain and function in patients with osteoarthritis.
In the short- and intermediate-term,
- Limited evidence found memantine to moderately improve pain, function, and quality of life in patients with fibromyalgia.
- For all conditions, evidence on long-term treatment effectiveness, comparative effectiveness, and quality of life is limited.
- Small to moderate, dose-dependent, increases in withdrawal due to adverse events was found with tricyclic antidepressants (TCAs), SNRIs duloxetine and milnacipran, pregabalin and gabapentin, and NSAIDs. Large increases were seen with oxcarbazepine.
- NSAIDs have increased risk of serious GI and CV adverse events.
For all conditions, evidence on long-term treatment effectiveness, comparative effectiveness, and quality of life is limited.