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Recommendations | 797 | Where can the guidance on management of SUD be found? | the VA/DoD SUD CPG | 452 | Some patients with SUD may disagree with the recommendation to use non-opioid modalities in lieu of LOT to treat their pain. However, the lack of evidence of efficacy of LOT and considerable evidence of significant harms of overdose, death from overdose, and increased risk of suicide outweigh any potential modest benefit of prescribing LOT in this population. See Recommendation 7 for additional information regarding UDT and risk mitigation. See the VA/DoD SUD CPG for guidance on management of SUD.10 | [
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] | the VA/DoD SUD CPG | 452 | 470 |
Recommendations | 1,054 | Is there any evidence of the comparative efficacy of tramadol versus another opioid or a non-opioid comparison such as non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen? | no long-term evidence | 205 | Tramadol: There is low quality evidence that tramadol may be more effective than placebo for pain relief. In one short-term study, compared to placebo, tramadol was more effective for pain.[146] There is no long-term evidence of the comparative efficacy of tramadol versus another opioid or a non-opioid comparison such as non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. Due to tramadol’s partial mu agonist activity and demonstrated safety profile when used in conjunction with acetaminophen in elderly patients, it may be a preferred agent in that patient group.[147,148] | [
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] | no long-term evidence | 205 | 227 |
Recommendations | 795 | Some patients with SUD may disagree with what? | the recommendation to use non-opioid modalities in lieu of LOT to treat their pain | 41 | Some patients with SUD may disagree with the recommendation to use non-opioid modalities in lieu of LOT to treat their pain. However, the lack of evidence of efficacy of LOT and considerable evidence of significant harms of overdose, death from overdose, and increased risk of suicide outweigh any potential modest benefit of prescribing LOT in this population. See Recommendation 7 for additional information regarding UDT and risk mitigation. See the VA/DoD SUD CPG for guidance on management of SUD.8 | [
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] | the recommendation to use non-opioid modalities in lieu of LOT to treat their pain | 41 | 124 |
Recommendations | 1,032 | In patients receiving LOT, who are 50% more likely to escalate to high-dose opioids and twice as likely to experience an opioid-related death? | men | 68 | In patients receiving LOT, moderate quality evidence indicated that men are 50% more likely (HR: 1.44, 95% CI: 1.21-1.70) to escalate to high-dose opioids (defined as >200 mg MEDD) and twice as likely to experience an opioid-related death (adjusted HR: 2.04, 95% CI: 1.18-3.53) compared to women.[136] Risk of opioid overdose morbidity or mortality is also increased in non-Hispanic white versus non-Hispanic black patients (moderate quality evidence).[59,136] | [
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] | men | 68 | 71 |