Teryl J. Nuckols, MD, MSHS; Roger Chou, MD
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1193.
Nuckols TJ, Chou R. Opioid Prescribing. Ann Intern Med. 2014;160:737-738. doi: 10.7326/L14-5010-2
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Published: Ann Intern Med. 2014;160(10):737-738.
We appreciate Dr. Manchikanti and colleagues’ interest but would like to correct some factual inaccuracies in their comment. First, we applied well-established, prespecified selection and evaluation criteria consistently across all guidelines. Criteria did not include whether guidelines were “restrictive” in the use of opioids. The Appraisal of Guidelines for Research and Evaluation II instrument and A Measurement Tool to Assess Systematic Reviews address potential conflicts of interest and funding (1).
In terms of updating, we used a cutoff of 5 years based on a study that found that about one half of 17 guidelines were out of date by 6 years (2). According to the Institute of Medicine, guidelines should be updated when new evidence suggests that key recommendations warrant modification (3, 4). We found no indication that recommendations in the APS-AAPM guideline were considered out of date. To the contrary, more recent guidelines—including the 2012 American Society of Interventional Pain Physicians guideline by Dr. Manchikanti and colleagues—frequently cite the APS-AAPM guideline (5).
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