Contents

• 1. Pharmacological management
  • 1.1. Review question: What is the clinical and cost effectiveness of pharmacological interventions for chronic primary pain?
  • 1.2. Introduction
  • 1.3. PICO table
  • 1.4. Clinical evidence
  • 1.5. Economic evidence
  • 1.6. Evidence statements
• 2. Long term safety of opioids for chronic pain
  • 2.1. Review question: What is the long-term safety of opioids for the management of chronic pain?
  • 2.2. Introduction
  • 2.3. PICO table
  • 2.4. Clinical evidence
  • 2.5. Economic evidence
  • 2.6. Evidence statements
• 3. Safety of gabapentinoids
  • 3.1. Review question: What is the long-term safety of gabapentinoids for the management of chronic pain?
  • 3.2. Introduction
  • 3.3. PICO table
  • 3.4. Clinical evidence
  • 3.5. Economic evidence
  • 3.6. Evidence statements
• 4. The committee’s discussion of the evidence
  • 4.1. Interpreting the evidence
  • 4.2. Cost effectiveness and resource use
  • 4.3. Other factors the committee took into account
• References
• Appendices
  • Appendix A. Review protocols
  • Appendix B. Literature search strategies
  • Appendix C. Clinical evidence selection
  • Appendix D. Clinical evidence tables
  • Appendix E. Forest plots
  • Appendix F. GRADE tables
  • Appendix G. Health economic evidence selection
  • Appendix H. Health economic evidence tables
  • Appendix I. Excluded studies
  • Appendix J. Research recommendations
  • Appendix K. MIDs for continuous outcomes

Intervention evidence review underpinning recommendations 1.2.7 to 1.2.15 and the research recommendation in the NICE guideline

This evidence review was developed by the National Guideline Centre based at the Royal College of Physicians

Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.

Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.