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      The impact of chronic pain on opioid addiction treatment: a systematic review protocol

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          The consequences of opioid relapse among patients being treated with opioid substitution treatment (OST) are serious and can result in abnormal cardiovascular function, overdose, and mortality. Chronic pain is a major risk factor for opioid relapse within the addiction treatment setting. There exist a number of opioid maintenance therapies including methadone, buprenorphine, naltrexone, and levomethadyl acetate (LAAM), of which the mediating effects of pain on treatment attrition, substance use behavior, and social functioning may differ across therapies. We aim to 1) evaluate the impact of pain on the treatment outcomes of addiction patients being managed with OST and 2) identify the most recently published opioid maintenance treatment guidelines from the United States, Canada, and the UK to determine how the evidence is being translated into clinical practice.


          The authors will search Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Database of Systematic Reviews, ProQuest Dissertations and theses Database, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. We will search and the National Institute for Care and Excellence (NICE) databases to identify the most recently published OST guidelines. All screening and data extraction will be completed in duplicate. Provided the data are suitable, we will perform a multiple treatment comparison using Bayesian meta-analytic methods to produce summary statistics estimating the effect of chronic pain on all OSTs. Our primary outcome is substance use behavior, which includes opioid and non-opioid substance use. We will also evaluate secondary endpoints such as treatment retention, general physical health, intervention adherence, personal and social functioning, as well as psychiatric symptoms.


          This review will capture the experience of treatment outcomes for a sub-population of opioid addiction patients and provide an opportunity to distinguish the best quality guidelines for OST. If chronic pain truly does result in negative consequences for opioid addiction patients, it is important we identify which OSTs are most appropriate for chronic pain patients as well as ensure the treatment guidelines incorporate this information.

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          Most cited references 34

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          Measuring inconsistency in meta-analyses.

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            The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

            Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website ( should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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              GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

              This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.

                Author and article information

                Syst Rev
                Syst Rev
                Systematic Reviews
                BioMed Central (London )
                16 April 2015
                16 April 2015
                : 4
                [ ]Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
                [ ]Population Genomics Program, Chanchlani Research Centre, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
                [ ]McMaster Integrative Neuroscience Discovery & Study (MiNDS) Program, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
                [ ]Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
                [ ]Canadian Addiction Treatment Centres, 13291 Yonge St #403, Richmond, Hill, Ontario L4E4L6 Canada
                [ ]Northern Ontario School of Medicine, 935 Ramsey Lake Rd, Sudbury, Ontario P3E 2C6 Canada
                [ ]Department of Medicine, Hamilton General Hospital, 237 Barton St East, Hamilton, Ontario L8L 2X2 Canada
                [ ]Hamilton Health Sciences, Population Health Research Institute, 237 Barton St East, Hamilton, Ontario L8L 2X2 Canada
                [ ]Departments of Pediatrics and Anesthesia, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
                [ ]St. Joseph’s Healthcare Hamilton, Centre for Evaluation of Medicine, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
                [ ]Biostatistics Unit, Father Sean O’Sullivan Research Centre, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
                [ ]Department of Psychiatry and Behavioral Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Ontario L8N 3K7 Canada
                [ ]Peter Boris Centre for Addictions Research, 100 West 5th Street, Hamilton, Ontario L8N 3K7 Canada
                © Dennis et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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