Hieu-Pham/cpgQA huggingface dataset:
Background information

Headache not responsive to other pain treatment modalities: LOT is an ineffective treatment  modality for patients with migraine headaches (with or without aura), tension-type headaches,  occipital neuralgia, or myofascial pain and may result in worsening of the underlying headache  condition through factors such as central sensitization and withdrawal. 

Question: What is an ineffective treatment modality for patients with myofascial pain?
Answer: LOT
Background information

Headache not responsive to other pain treatment modalities: LOT is an ineffective treatment  modality for patients with migraine headaches (with or without aura), tension-type headaches,  occipital neuralgia, or myofascial pain and may result in worsening of the underlying headache  condition through factors such as central sensitization and withdrawal. 

Question: What is an ineffective treatment modality for patients with migraine headaches (with or without aura), tension-type headaches, occipital neuralgia, or myofascial pain?
Answer: LOT
Background information

Headache not responsive to other pain treatment modalities: LOT is an ineffective treatment  modality for patients with migraine headaches (with or without aura), tension-type headaches,  occipital neuralgia, or myofascial pain and may result in worsening of the underlying headache  condition through factors such as central sensitization and withdrawal. 

Question: LOT is an ineffective treatment modality for patients with what kind of headaches?
Answer: migraine headaches (with or without aura), tension-type headaches,  occipital neuralgia, or myofascial pain
Background information

Headache not responsive to other pain treatment modalities: LOT is an ineffective treatment  modality for patients with migraine headaches (with or without aura), tension-type headaches,  occipital neuralgia, or myofascial pain and may result in worsening of the underlying headache  condition through factors such as central sensitization and withdrawal. 

Question: How may LOT affect patients with migraine headaches, tension-type headaches, occipital neuralgia, or myofascial pain?
Answer: may result in worsening of the underlying headache  condition through factors such as central sensitization and withdrawal
Background information

Headache not responsive to other pain treatment modalities: LOT is an ineffective treatment  modality for patients with migraine headaches (with or without aura), tension-type headaches,  occipital neuralgia, or myofascial pain and may result in worsening of the underlying headache  condition through factors such as central sensitization and withdrawal. 

Question: What treatment modality may result in worsening of the underlying headache condition in patients with migraine headaches, tension-type headaches, occipital neuralgia, or myofascial pain?
Answer: LOT
Background information

Traumatic brain injury (TBI): Patients with a history of TBI who use chronic short-acting and  long-acting opioids are more likely to attempt suicide.[61]  

Question: Who are more likely to attempt suicide?
Answer: Patients with a history of TBI who use chronic short-acting and  long-acting opioids
Background information

True allergy to opioid agents: Morphine causes a release of histamine that frequently results in  itching, but this does not constitute an allergic reaction. True allergy to opioid agents  (e.g., anaphylaxis) is not common, but does occur. Generally, allergy to one opioid does not  mean the patient is allergic to other opioids; many times, rotating to a different opioid may be  effective. When an opioid allergy is present and OT is being considered, consultation with an allergist may be helpful.

Question: Why does Morphine frequently cause itching?
Answer: Morphine causes a release of histamine
Background information

True allergy to opioid agents: Morphine causes a release of histamine that frequently results in  itching, but this does not constitute an allergic reaction. True allergy to opioid agents  (e.g., anaphylaxis) is not common, but does occur. Generally, allergy to one opioid does not  mean the patient is allergic to other opioids; many times, rotating to a different opioid may be  effective. When an opioid allergy is present and OT is being considered, consultation with an allergist may be helpful.

Question: What is an example of true allergy to opioid agents?
Answer: anaphylaxis
Background information

True allergy to opioid agents: Morphine causes a release of histamine that frequently results in  itching, but this does not constitute an allergic reaction. True allergy to opioid agents  (e.g., anaphylaxis) is not common, but does occur. Generally, allergy to one opioid does not  mean the patient is allergic to other opioids; many times, rotating to a different opioid may be  effective. When an opioid allergy is present and OT is being considered, consultation with an allergist may be helpful.

Question: When may a consultation with an allergist be helpful?
Answer: When an opioid allergy is present and OT is being considered
Background information

True allergy to opioid agents: Morphine causes a release of histamine that frequently results in  itching, but this does not constitute an allergic reaction. True allergy to opioid agents  (e.g., anaphylaxis) is not common, but does occur. Generally, allergy to one opioid does not  mean the patient is allergic to other opioids; many times, rotating to a different opioid may be  effective. When an opioid allergy is present and OT is being considered, consultation with an allergist may be helpful.

Question: What to do when an opioid allergy is present and OT is being considered?
Answer: consultation with an allergist may be helpful
Recommendations

a) We recommend against initiation of long-term opioid therapy for chronic pain. (Strong against) b) We recommend alternatives to opioid therapy such as self-management strategies and other non-pharmacological treatments. (Strong for) c) When pharmacologic therapies are used, we recommend non-opioids over opioids. (Strong for) (Reviewed, New-replaced)

Question: What is the recommendation regarding initiation of long-term opioid therapy for chronic pain?
Answer: recommend against
Recommendations

a) We recommend against initiation of long-term opioid therapy for chronic pain. (Strong against) b) We recommend alternatives to opioid therapy such as self-management strategies and other non-pharmacological treatments. (Strong for) c) When pharmacologic therapies are used, we recommend non-opioids over opioids. (Strong for) (Reviewed, New-replaced)

Question: What is the stance regarding alternatives to opioid therapy such as self-management strategies and other non-pharmacological treatments?
Answer: recommend
Recommendations

a) We recommend against initiation of long-term opioid therapy for chronic pain. (Strong against) b) We recommend alternatives to opioid therapy such as self-management strategies and other non-pharmacological treatments. (Strong for) c) When pharmacologic therapies are used, we recommend non-opioids over opioids. (Strong for) (Reviewed, New-replaced)

Question: When should non-opioids be recommended over opioids?
Answer: When pharmacologic therapies are used
Recommendations

a) We recommend against initiation of long-term opioid therapy for chronic pain. (Strong against) b) We recommend alternatives to opioid therapy such as self-management strategies and other non-pharmacological treatments. (Strong for) c) When pharmacologic therapies are used, we recommend non-opioids over opioids. (Strong for) (Reviewed, New-replaced)

Question: What are some alternatives to opioid therapy?
Answer: self-management strategies and other non-pharmacological treatments
Recommendations

As outlined in this CPG, there is a rapidly growing understanding of the significant harms of LOT even at  doses lower than 50 mg oral morphine equivalent daily dose [MEDD], including but not limited to  overdose and OUD. At the same time there is a lack of high quality evidence that LOT improves pain,  function, and/or quality of life. The literature review conducted for this CPG identified no studies  evaluating the effectiveness of LOT for outcomes lasting longer than 16 weeks. Given the lack of evidence  showing sustained functional benefit of LOT and moderate evidence outlining harms, non-opioid  treatments are preferred for chronic pain. Patient values, goals, concerns, and preferences must be  factored into clinical decision making on a case-by-case basis. When considering the initiation or  continuation of LOT, it is important to consider whether LOT will result in clinically meaningful  improvements in function such as readiness to return to work/duty and/or measurable improvement in  other areas of function, such that the benefits outweigh the potential harms. 

Question: Why non-opioid  treatments are preferred for chronic pain?
Answer: Given the lack of evidence  showing sustained functional benefit of LOT and moderate evidence outlining harms
Recommendations

As outlined in this CPG, there is a rapidly growing understanding of the significant harms of LOT even at  doses lower than 50 mg oral morphine equivalent daily dose [MEDD], including but not limited to  overdose and OUD. At the same time there is a lack of high quality evidence that LOT improves pain,  function, and/or quality of life. The literature review conducted for this CPG identified no studies  evaluating the effectiveness of LOT for outcomes lasting longer than 16 weeks. Given the lack of evidence  showing sustained functional benefit of LOT and moderate evidence outlining harms, non-opioid  treatments are preferred for chronic pain. Patient values, goals, concerns, and preferences must be  factored into clinical decision making on a case-by-case basis. When considering the initiation or  continuation of LOT, it is important to consider whether LOT will result in clinically meaningful  improvements in function such as readiness to return to work/duty and/or measurable improvement in  other areas of function, such that the benefits outweigh the potential harms. 

Question: In the literature review conducted for this CPG, are there any study evaluating the effectiveness of LOT for outcomes lasting longer than 16 weeks?
Answer: no
Recommendations

As outlined in this CPG, there is a rapidly growing understanding of the significant harms of LOT even at  doses lower than 50 mg oral morphine equivalent daily dose [MEDD], including but not limited to  overdose and OUD. At the same time there is a lack of high quality evidence that LOT improves pain,  function, and/or quality of life. The literature review conducted for this CPG identified no studies  evaluating the effectiveness of LOT for outcomes lasting longer than 16 weeks. Given the lack of evidence  showing sustained functional benefit of LOT and moderate evidence outlining harms, non-opioid  treatments are preferred for chronic pain. Patient values, goals, concerns, and preferences must be  factored into clinical decision making on a case-by-case basis. When considering the initiation or  continuation of LOT, it is important to consider whether LOT will result in clinically meaningful  improvements in function such as readiness to return to work/duty and/or measurable improvement in  other areas of function, such that the benefits outweigh the potential harms. 

Question: What must be factored into clinical decision making on a case-by-case basis?
Answer: Patient values, goals, concerns, and preferences
Recommendations

As outlined in this CPG, there is a rapidly growing understanding of the significant harms of LOT even at  doses lower than 50 mg oral morphine equivalent daily dose [MEDD], including but not limited to  overdose and OUD. At the same time there is a lack of high quality evidence that LOT improves pain,  function, and/or quality of life. The literature review conducted for this CPG identified no studies  evaluating the effectiveness of LOT for outcomes lasting longer than 16 weeks. Given the lack of evidence  showing sustained functional benefit of LOT and moderate evidence outlining harms, non-opioid  treatments are preferred for chronic pain. Patient values, goals, concerns, and preferences must be  factored into clinical decision making on a case-by-case basis. When considering the initiation or  continuation of LOT, it is important to consider whether LOT will result in clinically meaningful  improvements in function such as readiness to return to work/duty and/or measurable improvement in  other areas of function, such that the benefits outweigh the potential harms. 

Question: What needs to be considered when considering the initiation or continuation of LOT?
Answer: consider whether LOT will result in clinically meaningful  improvements in function such as readiness to return to work/duty and/or measurable improvement in  other areas of function, such that the benefits outweigh the potential harms
Recommendations

While there is currently no evidence in the literature documenting the benefit of LOT that demonstrates  improvement in pain and function, we recognize that in a rare subset of individuals a decision to initiate  LOT may be considered (e.g., for intermittent severe exacerbations of chronic painful conditions). If a  decision is made to initiate LOT, a careful assessment of benefits and risks should be made to ensure that  the benefits are expected to outweigh the well-documented risks. In addition, prior to this consideration, a  multimodal treatment plan should be integrated into the patient’s care. Once opioid therapy is initiated,  all opioid risk mitigation strategies outlined in this guideline (see Recommendation 7) should be put into  place.  

Question: What does the literature say about the the benefit of LOT?
Answer: there is currently no evidence in the literature documenting the benefit of LOT that demonstrates  improvement in pain and function
Recommendations

While there is currently no evidence in the literature documenting the benefit of LOT that demonstrates  improvement in pain and function, we recognize that in a rare subset of individuals a decision to initiate  LOT may be considered (e.g., for intermittent severe exacerbations of chronic painful conditions). If a  decision is made to initiate LOT, a careful assessment of benefits and risks should be made to ensure that  the benefits are expected to outweigh the well-documented risks. In addition, prior to this consideration, a  multimodal treatment plan should be integrated into the patient’s care. Once opioid therapy is initiated,  all opioid risk mitigation strategies outlined in this guideline (see Recommendation 7) should be put into  place.  

Question: What to do if a  decision is made to initiate LOT?
Answer: a careful assessment of benefits and risks should be made to ensure that  the benefits are expected to outweigh the well-documented risks
Recommendations

While there is currently no evidence in the literature documenting the benefit of LOT that demonstrates  improvement in pain and function, we recognize that in a rare subset of individuals a decision to initiate  LOT may be considered (e.g., for intermittent severe exacerbations of chronic painful conditions). If a  decision is made to initiate LOT, a careful assessment of benefits and risks should be made to ensure that  the benefits are expected to outweigh the well-documented risks. In addition, prior to this consideration, a  multimodal treatment plan should be integrated into the patient’s care. Once opioid therapy is initiated,  all opioid risk mitigation strategies outlined in this guideline (see Recommendation 7) should be put into  place.  

Question: What kind of treatment plan should be integrated into the patient’s care prrior to considering LOT?
Answer: multimodal
Recommendations

While there is currently no evidence in the literature documenting the benefit of LOT that demonstrates  improvement in pain and function, we recognize that in a rare subset of individuals a decision to initiate  LOT may be considered (e.g., for intermittent severe exacerbations of chronic painful conditions). If a  decision is made to initiate LOT, a careful assessment of benefits and risks should be made to ensure that  the benefits are expected to outweigh the well-documented risks. In addition, prior to this consideration, a  multimodal treatment plan should be integrated into the patient’s care. Once opioid therapy is initiated,  all opioid risk mitigation strategies outlined in this guideline (see Recommendation 7) should be put into  place.  

Question: What to do once opioid therapy is initiated?
Answer: all opioid risk mitigation strategies outlined in this guideline (see Recommendation 7) should be put into  place
Recommendations

In 2011, in response to the recognition of pain and its management as a public health problem, the  National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. The report called for a cultural transformation in the way pain is viewed and  treated.[3] Accordingly, the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommends a biopsychosocial approach to pain care that is multimodal and  interdisciplinary.[26] The underlying concepts of the biopsychosocial model of pain include the idea that  pain perception and its effects on the patient’s function is mediated by multiple factors (e.g., mood, social  support, prior experience, biomechanical factors), not just biology alone. With this overall change in  construct, a biopsychosocial assessment and treatment plan should be tailored accordingly.  

Question: Why did the National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. in 2011?
Answer: in response to the recognition of pain and its management as a public health problem
Recommendations

In 2011, in response to the recognition of pain and its management as a public health problem, the  National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. The report called for a cultural transformation in the way pain is viewed and  treated.[3] Accordingly, the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommends a biopsychosocial approach to pain care that is multimodal and  interdisciplinary.[26] The underlying concepts of the biopsychosocial model of pain include the idea that  pain perception and its effects on the patient’s function is mediated by multiple factors (e.g., mood, social  support, prior experience, biomechanical factors), not just biology alone. With this overall change in  construct, a biopsychosocial assessment and treatment plan should be tailored accordingly.  

Question: In response to the recognition of pain and its management as a public health problem in 2011, who investigated and reported on the state of pain research, treatment, and  education in the U.S.?
Answer: the  National Academy of Medicine
Recommendations

In 2011, in response to the recognition of pain and its management as a public health problem, the  National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. The report called for a cultural transformation in the way pain is viewed and  treated.[3] Accordingly, the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommends a biopsychosocial approach to pain care that is multimodal and  interdisciplinary.[26] The underlying concepts of the biopsychosocial model of pain include the idea that  pain perception and its effects on the patient’s function is mediated by multiple factors (e.g., mood, social  support, prior experience, biomechanical factors), not just biology alone. With this overall change in  construct, a biopsychosocial assessment and treatment plan should be tailored accordingly.  

Question: In response to the recognition of pain and its management as a public health problem in 2011, what was investigated and reported by the National Academy of Medicine?
Answer: the state of pain research, treatment, and  education in the U.S.
Recommendations

In 2011, in response to the recognition of pain and its management as a public health problem, the  National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. The report called for a cultural transformation in the way pain is viewed and  treated.[3] Accordingly, the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommends a biopsychosocial approach to pain care that is multimodal and  interdisciplinary.[26] The underlying concepts of the biopsychosocial model of pain include the idea that  pain perception and its effects on the patient’s function is mediated by multiple factors (e.g., mood, social  support, prior experience, biomechanical factors), not just biology alone. With this overall change in  construct, a biopsychosocial assessment and treatment plan should be tailored accordingly.  

Question: What was the impact of the report on the state of pain research, treatment, and  education in the U.S. by the National Academy of Medicine in 2011?
Answer: The report called for a cultural transformation in the way pain is viewed and  treated.
Recommendations

In 2011, in response to the recognition of pain and its management as a public health problem, the  National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. The report called for a cultural transformation in the way pain is viewed and  treated.[3] Accordingly, the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommends a biopsychosocial approach to pain care that is multimodal and  interdisciplinary.[26] The underlying concepts of the biopsychosocial model of pain include the idea that  pain perception and its effects on the patient’s function is mediated by multiple factors (e.g., mood, social  support, prior experience, biomechanical factors), not just biology alone. With this overall change in  construct, a biopsychosocial assessment and treatment plan should be tailored accordingly.  

Question: What does the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommend?
Answer: a biopsychosocial approach to pain care that is multimodal and  interdisciplinary
Recommendations

In 2011, in response to the recognition of pain and its management as a public health problem, the  National Academy of Medicine investigated and reported on the state of pain research, treatment, and  education in the U.S. The report called for a cultural transformation in the way pain is viewed and  treated.[3] Accordingly, the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016) recommends a biopsychosocial approach to pain care that is multimodal and  interdisciplinary.[26] The underlying concepts of the biopsychosocial model of pain include the idea that  pain perception and its effects on the patient’s function is mediated by multiple factors (e.g., mood, social  support, prior experience, biomechanical factors), not just biology alone. With this overall change in  construct, a biopsychosocial assessment and treatment plan should be tailored accordingly.  

Question: Who does recommend a biopsychosocial approach to pain care that is multimodal and interdisciplinary?
Answer: the U.S. Department of Health and Human Services (HHS) National Pain Strategy  (March 2016)