Lornng/cpgQA huggingface dataset:
Background information

Concurrent with the increase in prescription opioid use, the rate of heroin overdose deaths increased  nearly four-fold between 2000 and 2013. According to a survey of patients entering SUD treatment for  heroin use, the prescription opioid epidemic has resulted in a marked shift in how and which opioids are  abused. In the 1960s, 80% of people entering treatment for heroin use started using heroin as their first opioid, while in the 2000s, 75% of people entering treatment for heroin use started using prescription opioids as their first opioid. This increase in the use of opioids, as well as associated morbidity, mortality, and other adverse outcomes, has called attention to the need for a paradigm shift in pain and in the way it is treated. Consult the VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders (VA/DoD SUD CPG) for further information.

Question: Between 2000 and 2013, what increased along with the increment of prescription opioid use?
Answer: the rate of heroin overdose deaths

Question: How much did the rate of heroin overdose deaths increase between 2000 and 2013?
Answer: nearly four-fold

Question: What percentage of people entering SUD treatment for heroin use started using heroin as their first opioid in the 1960s?
Answer: 80%

Question: What percentage of people entering SUD treatment for heroin use started using prescription opioids as their first opioid in the 2000s?
Answer: 75%

Question: What was the first opioid used by most of the people entering SUD treatment for heroin use in the 1960s?
Answer: heroin

Question: What was the first opioid used by most of the people entering SUD treatment for heroin use in the 2000s?
Answer: prescription opioids

Question: What called attention to the need for a paradigm shift in pain and its treatment protocols?
Answer: increase in the use of opioids, as well as associated morbidity, mortality, and other adverse outcomes

Question: Where can further information on SUD treatment be found?
Answer: the VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders (VA/DoD SUD CPG)

Question: What is VA/DoD SUD CPG?
Answer: VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders
Background information

The U.S. is in the midst of a cultural transformation in the way pain is viewed and treated. The biomedical model of pain care, in which the pain experience is reduced to a pain generator and pain treatment is aimed at fixing or numbing pain with medications, interventions, or surgery, dominated the 1990s and the first decade of the 2000s. As the cost, potential harm, and limited effectiveness of the approach in the biomedical model of pain care to chronic pain was becoming apparent, the National Academy of Medicine issued a call for the transformation of pain care to a biopsychosocial, multimodal, interdisciplinary model.

Question: In which way the U.S. is in the midst of cultural transformation?
Answer: in the way pain is viewed and treated

Question: What is the trend in pain management and care in the U.S.?
Answer: The U.S. is in the midst of a cultural transformation in the way pain is viewed and treated

Question: What happens in the biomedical model of pain care?
Answer: the pain experience is reduced to a pain generator and pain treatment is aimed at fixing or numbing pain with medications, interventions, or surgery

Question: What is the aim of the pain treatment in the biomedical model of pain care?
Answer: fixing or numbing pain with medications, interventions, or surgery

Question: Which was the dominating period of the biomedical model of pain care?
Answer: the 1990s and the first decade of the 2000s

Question: Why did the National Academy of Medicine issue a call for the transformation of pain care to a biopsychosocial, multimodal, interdisciplinary model?
Answer: As the cost, potential harm, and limited effectiveness of the approach in the biomedical model of pain care to chronic pain was becoming apparent

Question: Which model was adopted after the biomedical model of pain care?
Answer: a biopsychosocial, multimodal, interdisciplinary model
Background information

A paradigm shift in the use of OT for chronic non-terminal pain has paralleled this transformation in pain  care. Prior to the 1980s, OT was rarely used outside of severe acute injury or post-surgical pain, primarily due to concern for tolerance, physical dependence, and addiction. As the hospice and palliative care  movement began defining end-of-life care in the U.S. during the 1980s and emphasizing the importance of  pain relief, OT increasingly became a mainstay for cancer and end-of-life pain. Efforts to destigmatize the use of prescription opioids for chronic non-terminal pain encompassed primary care providers and the  public. The efforts led to an unprecedented increase in opioid prescribing for chronic non-terminal pain.  Chronic pain management became synonymous with LOT in the 1990s and the first decade of the 2000s  with significant numbers of patients in pain clinics receiving LOT. Despite the absence of long-term safety or efficacy data, OT for chronic non-terminal pain became a mainstay of therapy. However, as observational and epidemiologic data of harm from LOT accumulated, a much more cautious approach to  OT for chronic non-terminal pain has emerged in the decade of the 2010s.

Question: What happened concurrently with the transformation in pain care?
Answer: A paradigm shift in the use of OT for chronic non-terminal pain

Question: How was OT used prior to 1980s?
Answer: rarely used outside of severe acute injury or post-surgical pain, primarily due to concern for tolerance, physical dependence, and addiction

Question: Name the concerning factors regarding the use of OT prior to 1980s.
Answer: tolerance, physical dependence, and addiction

Question: How did OT increasingly become a mainstay for cancer and end-of-life pain?
Answer: As the hospice and palliative care  movement began defining end-of-life care in the U.S. during the 1980s and emphasizing the importance of  pain relief

Question: Which efforts led to an unprecedented increase in opioid prescribing for chronic non-terminal pain?
Answer: Efforts to destigmatize the use of prescription opioids for chronic non-terminal pain

Question: Which became synonymous with LOT in the 1990s and the first decade of the 2000s?
Answer: Chronic pain management

Question: When did chronic pain management became synonymous with LOT?
Answer: in the 1990s and the first decade of the 2000s

Question: What was the state of long-term safety or efficacy data when OT for chronic non-terminal pain became a mainstay of therapy?
Answer: absence

Question: When did a more cautious approach to OT for chronic non-terminal pain emerge?
Answer: in the decade of the 2010s

Question: How did a more cautious approach to OT for chronic non-terminal pain emerge?
Answer: as observational and epidemiologic data of harm from LOT accumulated
Background information

The accumulation of evidence of harms and the absence of evidence of long-term benefits has warranted  a newly cautious approach to LOT that prioritizes safety. This approach coupled with the evidence of both the safety and efficacy for non-pharmacologic and non-opioid pharmacologic pain therapies has led to the  current transformation in the way in which pain is viewed and treated. The biopsychosocial model of pain recognizes pain as a complex multidimensional experience that requires multimodal and integrated care approaches. Within this context, non-pharmacologic treatments and non-opioid medications are the preferred treatments for chronic non-terminal pain. OT has a limited role, primarily in the treatment of severe acute pain, post-operative pain, and end-of-life pain.

Question: What warranted a cautious approach to LOT prioritizing safety?
Answer: The accumulation of evidence of harms and the absence of evidence of long-term benefits

Question: What was coupled with the newly cautious approach to LOT?
Answer: the evidence of both the safety and efficacy for non-pharmacologic and non-opioid pharmacologic pain therapies

Question: How is pain recognized by the biopsychosocial model of pain?
Answer: as a complex multidimensional experience that requires multimodal and integrated care approaches

Question: What are the preferred treatments for chronic non-terminal pain?
Answer: non-pharmacologic treatments and non-opioid medications

Question: Where does OT have a limited role?
Answer: primarily in the treatment of severe acute pain, post-operative pain, and end-of-life pain

Question: What is the role of OT in the treatment of severe acute pain, post-operative pain, and end-of-life pain?
Answer: limited
Background information

The increasing use of opioids, as well as the accompanying rise in morbidity and mortality associated with opioid use, has garnered increasing attention from federal and local officials as well as other policy makers. This public health issue, which has been labeled an epidemic,  became a focus of the President’s  National Drug Control Strategy in 2010 and has since remained a focus. Two main goals introduced in the  2010 strategy included curtailing illicit drug consumption in America and improving the health and safety of the American people by reducing the consequences of drug abuse. The 2015 strategy, and an accompanying presidential memorandum on preventing prescription drug abuse and heroin use, released in October 2015, encouraged the improvement of health and safety using evidence-based methods by calling for change in a number of key areas including preventing drug use in communities, seeking early intervention opportunities, and integrating SUD treatment and supporting recovery.

Question: What has accumulated growing attention from federal and local officials as well as other policymakers?
Answer: The increasing use of opioids, as well as the accompanying rise in morbidity and mortality associated with opioid use

Question: Which health issue has been identified as an epidemic?
Answer: The increasing use of opioids

Question: In 2010, what was the focus of National Drug Control Strategy?
Answer: The increasing use of opioids

Question: What were the goals of President’s National Drug Control strategy in 2010?
Answer: curtailing illicit drug consumption in America and improving the health and safety of the American people by reducing the consequences of drug abuse

Question: When was the 2015 National Drug Control strategy released?
Answer: October 2015

Question: What accompanied the 2015 National Drug Control strategy?
Answer: presidential memorandum on preventing prescription drug abuse and heroin use

Question: How did the 2015 National Drug Control strategy and an accompanying presidential memorandum encourage the improvement of health and safety using evidence-based methods regarding SUD treatments?
Answer: by calling for change in a number of key areas including preventing drug use in communities, seeking early intervention opportunities, and integrating SUD treatment and supporting recovery
Background information

With the passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010, the  Interagency Pain Research Coordinating Committee was created to coordinate pain research efforts  throughout federal government agencies. The Committee was tasked with summarizing advances in pain  care research, identifying gaps in research, and developing recommendations regarding ways to minimize  duplicative efforts, disseminate pain care information, and expand public/private research partnerships  and collaborations. The Committee published the National Pain Strategy in March 2016 in response to the  call from the National Academy of Medicine to increase awareness of pain as a significant public health  issue in the U.S. The strategy made recommendations in a number of areas including prevention and  care, professional education and training, and population research. The plan is aimed at decreasing the  prevalence of all types of pain (acute and chronic) in the U.S., as well as the disability and morbidity  associated with pain.

Question: How was the Interagency Pain Research Coordinating Committee created?
Answer: With the passage of the Patient Protection and Affordable Care Act (PPACA) in March 2010

Question: What was the purpose of  Interagency Pain Research Coordinating Committee?
Answer: coordinate pain research efforts  throughout federal government agencies

Question: When was the Interagency Pain Research Coordinating Committee created?
Answer: March 2010

Question: What was the tasks of Interagency Pain Research Coordinating Committee?
Answer: summarizing advances in pain  care research, identifying gaps in research, and developing recommendations regarding ways to minimize  duplicative efforts, disseminate pain care information, and expand public/private research partnerships  and collaborations

Question: Who published the National Pain Strategy?
Answer: The Committee

Question: When was the National Pain Strategy published?
Answer: March 2016

Question: How was the National Pain Strategy published?
Answer: in response to the  call from the National Academy of Medicine to increase awareness of pain as a significant public health  issue in the U.S.

Question: In which areas the National Pain Strategy made recommendations?
Answer: prevention and  care, professional education and training, and population research

Question: What was the aim of the National Pain Strategy?
Answer: decreasing the  prevalence of all types of pain (acute and chronic) in the U.S., as well as the disability and morbidity  associated with pain
Background information

Other initiatives are aimed at improving the safe use of opioids, including the OSI Toolkit and the patient  guide “Taking Opioids Responsibly for Your Safety and the Safety of Others: Patient Information Guide on  Long-term Opioid Therapy for Chronic Pain”. The OSI Toolkit was developed to provide clinicians with  materials to inform clinical decision-making regarding opioid therapy and safe opioid prescribing. The  toolkit materials can be found at the following link: https://www.va.gov/PAINMANAGEMENT/Opioid_Safety_Initiative_Toolkit.asp. “Taking Opioids Responsibly  for Your Safety and the Safety of Others: Patient Information Guide on Long-term Opioid Therapy for  Chronic Pain” is aimed at providing information to patients as well as their providers regarding the safe use  of opioids. More information can be found at the following link: http://www.healthquality.va.gov/guidelines/Pain/cot/OpiodTheraphyforChronicPainPatientTool20May20 13print.pdf. To further promote safety and patient centered care, the VHA issued a policy in 2014 requiring  standardized education and signature informed consent for all patients receiving LOT for non-cancer  pain.

Question: Name two initiatives that are aimed at improving the safe use of opioids? 
Answer: OSI Toolkit and the patient  guide “Taking Opioids Responsibly for Your Safety and the Safety of Others: Patient Information Guide on  Long-term Opioid Therapy for Chronic Pain”

Question: What was the purpose of the OSI toolkit?
Answer: provide clinicians with  materials to inform clinical decision-making regarding opioid therapy and safe opioid prescribing

Question: Where can the OSI toolkit materials be found? 
Answer: https://www.va.gov/PAINMANAGEMENT/Opioid_Safety_Initiative_Toolkit.asp

Question: What is the aim of the patient guide?
Answer: providing information to patients as well as their providers regarding the safe use  of opioids

Question: Where can more information be found on the patient guide?
Answer: http://www.healthquality.va.gov/guidelines/Pain/cot/OpiodTheraphyforChronicPainPatientTool20May20 13print.pdf

Question: Who issued a policy requiring  standardized education and signature informed consent for all patients receiving LOT for non-cancer  pain? 
Answer: the VHA

Question: Why did VHA issue a policy requiring  standardized education and signature informed consent for all patients receiving LOT for non-cancer  pain? 
Answer: To further promote safety and patient centered care

Question: When did VHA issue a policy requiring  standardized education and signature informed consent for all patients receiving LOT for non-cancer  pain? 
Answer: in 2014

Question: What are the requirements in the policy issued by the VHA to further promote safety and patient centered care?
Answer: standardized education and signature informed consent for all patients receiving LOT for non-cancer  pain
Background information

The presidential memorandum of October 2015 mandated that executive departments and agencies shall, to the extent permitted by law, provide training on the appropriate and effective prescribing of opioid medications to all employees who are health care professionals and who prescribe controlled substances as part of their federal responsibilities and duties. The DoD Opioid Prescriber Safety  Training Program, launched accordingly, includes modules on pain management and opioid prescribing safety, the recent Centers for Disease Control and Prevention (CDC) guideline, and the identification of substance misuse and referral to specialized services. Defense Centers of  Excellence for Psychological Health and Traumatic Brain Injury is sponsoring the training and related management support. Training is available online at http://opstp.cds.pesgce.com/hub.php.

Question: What was mandated by the presidential memorandum of October 2015?
Answer: executive departments and agencies shall, to the extent permitted by law, provide training on the appropriate and effective prescribing of opioid medications to all employees who are health care professionals and who prescribe controlled substances as part of their federal responsibilities and duties

Question: Who mandated training on the appropriate and effective prescribing of opioid medications to all employees who are health care professionals?
Answer: The presidential memorandum of October 2015

Question: Who mandated training on the appropriate and effective prescribing of opioid medications to all employees who prescribe controlled substances as part of their federal responsibilities and duties?
Answer: The presidential memorandum of October 2015

Question: What does the DoD Opioid Prescriber Safety  Training Program include?
Answer: modules on pain management and opioid prescribing safety, the recent Centers for Disease Control and Prevention (CDC) guideline, and the identification of substance misuse and referral to specialized services

Question: Which training program was launched according to the mandate by the presidential memorandum of October 2015?
Answer: DoD Opioid Prescriber Safety  Training Program

Question: Who is sponsoring the training and related management support?
Answer: Defense Centers of  Excellence for Psychological Health and Traumatic Brain Injury

Question: Where can the DoD Opioid Prescriber Safety  Training Program be found?
Answer: http://opstp.cds.pesgce.com/hub.php
Background information

The CDC released its Guideline for Prescribing Opioids for Chronic Pain, directed toward primary care physicians, on March 15, 2016. The aim of the guideline is to assist primary care providers in offering safe and effective treatment for patients with chronic pain in the outpatient setting (not including active cancer treatment, palliative care, or end-of-life care). It is also aimed at improving communication between providers and patients and decreasing adverse outcomes associated with LOT. The CDC guideline,  similar to the VA/DoD OT CPG, covered topics including initiation and continuation of OT, management of  OT, and risk assessment and use of risk mitigation strategies. It also used the GRADE system to assign a  grade for the strength for each recommendation which includes assessment of the quality of the evidence and consideration of the balance of desirable and undesirable outcomes, patient values and preferences,  and other considerations (e.g., resource use, equity) during recommendation development.

Question: Who are the targeted individuals for the CDC Guideline for Prescribing Opioids for Chronic Pain?
Answer: primary care physicians

Question: When did the CDC released its Guideline for Prescribing Opioids for Chronic Pain? 
Answer: March 15, 2016

Question: What is the aim of the CDC Guideline for Prescribing Opioids for Chronic Pain?
Answer: assist primary care providers in offering safe and effective treatment for patients with chronic pain in the outpatient setting (not including active cancer treatment, palliative care, or end-of-life care). It is also aimed at improving communication between providers and patients and decreasing adverse outcomes associated with LOT.

Question: Which topics are covered in the CDC Guideline for Prescribing Opioids for Chronic Pain?
Answer: initiation and continuation of OT, management of  OT, and risk assessment and use of risk mitigation strategies

Question: Which system is used by the CDC guideline to assign a  grade for the strength for each recommendation? 
Answer: GRADE system

Question: What does the GRADE system include?
Answer: assessment of the quality of the evidence and consideration of the balance of desirable and undesirable outcomes, patient values and preferences,  and other considerations (e.g., resource use, equity) during recommendation development
Background information

On July 22, 2016, the Comprehensive Addiction and Recovery Act (CARA) was enacted with the aim of addressing the epidemic of overdoses from prescription opioids and other prescription drugs and heroin. While this act was primarily focused on opioid abuse treatment and prevention, it also gave specific instruction to the VA in regard to broad aspects of OT including consideration of the CDC guideline in revising the prior VA/DoD OT CPG and adopting it for the VA. There are, however, some important distinctions between the CDC guideline and the VA/DoD OT CPG.

Question: What is CARA?
Answer: the Comprehensive Addiction and Recovery Act

Question: When was CARA enacted?
Answer: July 22, 2016

Question: What is the aim of CARA?
Answer: addressing the epidemic of overdoses from prescription opioids and other prescription drugs and heroin

Question: What is the primary focus of the CARA?
Answer: opioid abuse treatment and prevention
Background information

The VA/DoD OT CPG was developed with a specific patient population in mind—Service Members,  Veterans, and their families—that has unique characteristics and needs related to the military culture and communities to which they return. Throughout the VA/DoD OT CPG, attention is paid to the characteristics and needs of these patients, particularly regarding specific risk factors such as risk for suicide, SUD, and other medical and mental health co-occurring conditions that may complicate the management of pain for these patients. Further, these recommendations were made keeping in mind the implications they would  have within the VA/DoD healthcare settings, particularly regarding considerations such as resource use, accessibility, and equity related to each recommendation and the urgent need for rigorous attention to the balance of risks and benefits for patients within the VA/DoD specifically.

Question: Who are the target population for the VA/DoD OT CPG?
Answer: Service Members,  Veterans, and their families—that has unique characteristics and needs related to the military culture and communities to which they return

Question: Throughout the VA/DoD OT CPG, particular attention is paid regarding which factors?
Answer: specific risk factors such as risk for suicide, SUD, and other medical and mental health co-occurring conditions that may complicate the management of pain for these patients

Question: What was the considerations behind the recommendations made in the CPG?
Answer: the implications they would  have within the VA/DoD healthcare settings, particularly regarding considerations such as resource use, accessibility, and equity related to each recommendation and the urgent need for rigorous attention to the balance of risks and benefits for patients within the VA/DoD specifically