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Effective Health Care Program

Treatment for Acute Pain: An Evidence Map

Technical Brief Draft

Open for comment through Apr 25, 2019

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Purpose of Review

The purpose of this evidence map is to provide a high-level overview of the current guidelines and systematic reviews on pharmacologic and nonpharmacologic treatments for acute pain. We map the evidence for several acute pain conditions including postoperative pain, dental pain, neck pain, back pain, renal colic, acute migraine, and sickle cell crisis. Improved understanding of the interventions studied for each of these acute pain conditions will provide insight on which topics are ready for comprehensive comparative effectiveness review.

Key Messages

  • Few systematic reviews provide a comprehensive rigorous assessment of all potential interventions to treat pain attributable to each acute pain condition. Acute pain conditions that may need a comprehensive systematic review or overview of systematic reviews include postoperative postdischarge pain, acute back pain, acute neck pain, renal colic, and acute migraine.
  • Certain acute pain conditions have many published systematic reviews: postoperative pain, pain associated with dental procedures and oral surgery, low back pain, acute migraine.
  • Several acute pain conditions have sufficient new data to warrant a new systematic review: pain associated with dental procedures and oral surgery, low back pain, renal colic, acute migraine.
  • Few systematic reviews of acute pain treatments examine outcomes other than very short-term outcomes. Pain during the week or month following the inciting event and persistent opioid use were rarely reported.
  • Most systematic reviews report pain outcomes using scales that measure only pain intensity, while few assess function or other pain characteristics.
  • Few reviews focused on specific settings or populations other than general adults or children and adolescents.

Structured Abstract

Introduction. Acute pain is a common ailment in the U.S. often treated with opioids. This technical brief maps the current evidence on pain treatments for select acute pain conditions (postdischarge postoperative pain, musculoskeletal pain, acute migraine, dental pain, renal colic, and acute pain associated with sickle cell disease).

Methods. We conducted Key Informant discussions to develop the context around the acute pain conditions, settings, and current clinical practice. We then conducted a systematic literature search to identify recent systematic reviews of sufficient quality that evaluated pain treatments for select acute pain conditions. We screened results and extracted relevant data into evidence tables. We subsequently searched for original research published since systematic review search dates.

Results. Key Informant discussions identified important issues regarding common acute pain conditions and treatments. Certain acute pain conditions have not received sufficient attention in rigorous comprehensive systematic review; for most types of acute pain, pain etiology is critical to selecting appropriate treatment; the value of acute pain assessments in guiding treatment decisions is unclear; and regional and health system level policies play a large role in treatment decisions. Our search for systematic reviews for pain treatments for priority acute pain conditions identified 1226 potentially relevant references, of which 527 underwent full text review. After supplemental searching and full text review, 110 systematic reviews met basic eligibility criteria. Most acute pain conditions had systematic reviews that met eligibility criteria, but few reviews were sufficiently rigorous and comprehensive. Few reviews focused on specific settings except emergency settings for several acute pain conditions. Specific populations other than general adults or children and adolescents, were rarely addressed. Comparisons addressed by many systematic reviews often included opioids. Few systematic reviews focused on outcomes beyond the initial treatment period.

Discussion. Our discussions with Key Informants and review of the literature show that additional original research and up-do-date comprehensive systematic reviews would provide valuable information to inform treatment decisions for a wide variety of acute pain conditions.