Review

Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Corresponding Author

Shoshana J. Herzig MD, MPH

n/[email protected]

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Harvard Medical School, Boston, Massachusetts

Address for correspondence: Shoshana J. Herzig, MD, MPH, Beth Israel Deaconess Medical Center, 330 Brookline Ave, CO-1309, Boston, MA 02215; Telephone: (617) 754-1413; Fax: (617) 754-1440.Search for more papers by this author

Susan L. Calcaterra MD, MPH,

Susan L. Calcaterra MD, MPH

Department of Medicine, Denver Health Medical Center, Denver, Colorado

Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora, Colorado

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Hilary J. Mosher MD,

Hilary J. Mosher MD

The Comprehensive Access and Delivery Research and Evaluation Center at the Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa

Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Matthew V. Ronan MD,

Matthew V. Ronan MD

Harvard Medical School, Boston, Massachusetts

Department of Internal Medicine, West Roxbury Medical Center, Veterans Health Administration Boston Healthcare System, West Roxbury, Massachusetts

Boston University School of Medicine, Boston, Massachusetts

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Nicole Van Groningen MD,

Nicole Van Groningen MD

Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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Lili Shek MD,

Lili Shek MD

Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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Anthony Loffredo MD,

Anthony Loffredo MD

Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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Michelle Keller MPH,

Michelle Keller MPH

Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California

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Anupam B. Jena MD, PhD,

Anupam B. Jena MD, PhD

Harvard Medical School, Boston, Massachusetts

Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts

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Teryl K. Nuckols MD,

Teryl K. Nuckols MD

Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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Shoshana J. Herzig MD, MPH,

Corresponding Author

Shoshana J. Herzig MD, MPH

n/[email protected]

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Harvard Medical School, Boston, Massachusetts

Susan L. Calcaterra MD, MPH,

Susan L. Calcaterra MD, MPH

Department of Medicine, Denver Health Medical Center, Denver, Colorado

Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora, Colorado

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Hilary J. Mosher MD,

Hilary J. Mosher MD

The Comprehensive Access and Delivery Research and Evaluation Center at the Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa

Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa

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Matthew V. Ronan MD,

Matthew V. Ronan MD

Harvard Medical School, Boston, Massachusetts

Department of Internal Medicine, West Roxbury Medical Center, Veterans Health Administration Boston Healthcare System, West Roxbury, Massachusetts

Boston University School of Medicine, Boston, Massachusetts

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Nicole Van Groningen MD,

Nicole Van Groningen MD

Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California

Search for more papers by this author

Lili Shek MD,

Lili Shek MD

Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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Anthony Loffredo MD,

Anthony Loffredo MD

Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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Michelle Keller MPH,

Michelle Keller MPH

Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, California

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Anupam B. Jena MD, PhD,

Anupam B. Jena MD, PhD

Harvard Medical School, Boston, Massachusetts

Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts

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Teryl K. Nuckols MD,

Teryl K. Nuckols MD

Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California

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First published: 01 April 2018

https://doi.org/10.12788/jhm.2979

Citations: 19

Additional Supporting Information may be found in the online version of this article.

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Abstract

BACKGROUND

Pain is common among hospitalized patients. Inpatient prescribing of opioids is not without risk. Acute pain management guidelines could inform safe prescribing of opioids in the hospital and limit associated unintended consequences.

PURPOSE

To evaluate the quality and content of existing guidelines for acute, noncancer pain management.

DATA SOURCES

The National Guideline Clearinghouse, MEDLINE via PubMed, websites of relevant specialty societies and other organizations, and selected international search engines.

STUDY SELECTION

Guidelines published between January 2010 and August 2017 addressing acute, noncancer pain management among adults were considered. Guidelines that focused on chronic pain, specific diseases, and the nonhospital setting were excluded.

DATA EXTRACTION

Quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.

DATA SYNTHESIS

Four guidelines met the selection criteria. Most recommendations were based on expert consensus. The guidelines recommended restricting opioids to severe pain or pain that has not responded to nonopioid therapy, using the lowest effective dose of short-acting opioids for the shortest duration possible, and co-prescribing opioids with nonopioid analgesics. The guidelines generally recommended checking the prescription drug monitoring program when prescribing opioids, developing goals for patient recovery, and educating patients regarding the risks and side effects of opioid therapy. Additional recommendations included using an opioid-dose conversion guide, avoidance of co-administration of parenteral and oral opioids, and using caution when co-prescribing opioids with other central nervous system depressants.

CONCLUSIONS

Guidelines, based largely on expert opinion, recommend judicious prescribing of opioids for severe, acute pain. Future work should assess the implications of these recommendations on hospital-based pain management.

Supporting Information

References

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Citing Literature

Volume13, Issue4

April 2018

Pages 256-262

Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Abstract

BACKGROUND

PURPOSE

DATA SOURCES

STUDY SELECTION

DATA EXTRACTION

DATA SYNTHESIS

CONCLUSIONS

Supporting Information

References

Citing Literature

References

Information

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Safe Opioid Prescribing for Acute Noncancer Pain in Hospitalized Adults: A Systematic Review of Existing Guidelines

Abstract

BACKGROUND

PURPOSE

DATA SOURCES

STUDY SELECTION

DATA EXTRACTION

DATA SYNTHESIS

CONCLUSIONS

Supporting Information

References

Citing Literature

References

Related

Information