Systematic searches on PubMed and Cochrane databases were conducted to identify relevant recommendations and evidence levels to guide GP prescribing of opioids in acute pain and CNCP.
The literature search was divided into two sections. Stage I of the literature search was performed to identify guidelines, health assessments and systematic reviews in order to facilitate guidance on opioid prescribing in acute conditions and CNCP. Further literature analysis (Stage II) was performed to identify the overall management of acute conditions and CNCP. Several publications on guideline comparisons were used.
Other selected publications and references were also considered with respect to individual conditions or drugs under consideration.
To ensure consistency with other Australian guidelines, state health-based publications, Hunter Regional Health, and publications from the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (ANZCA) were also included. External sources of recommendations include the management of pain in acute patient settings, for aged care facilities, GP after-hours services and within general practices.
The pharmacology of opioids, common concerns involving side effects and adverse reactions, and the principles of prescribing were collated from reputable national and international texts.
The RACGP has made a decision to transition to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.6 This method specifies the systematic review of scientific evidence and offers a transparent approach to grading quality of evidence and strength of recommendations. The method grades the overall quality of each body of evidence as high, moderate, low, or very low.
High-quality publications using the GRADE approach were selected for consideration. Due to the recency and robustness of development, the Centers for Disease Control and Prevention (CDC) publication on opioids formed the basis for many of the final recommendations on the management of CNCP with opioids.
However, where supported by the evidence, Australian context-generated recommendations are asserted in these guidelines.
All conflicts of interest were managed according to RACGP policy.
The Expert Group members wish to disclose they have no financial conflicts of interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters.
Two consultation periods involved broad stakeholder (including consumer organisations) input to the guidelines. A list of all consultation bodies is found in the introductory pages.
The guideline is freely available on the RACGP website. It contains infrastructure for feedback, and a section for detailing/logging updates and corrections.