The Centers for Disease and Prevention (CDC) has released updated recommendations for clinicians who are prescribing opioids for adult outpatients with acute (duration <1 month), subacute (duration of 1 to 3 months), and chronic (duration of >3 months) pain, excluding pain management related to sickle cell disease, cancer-related pain treatment, palliative care, and end-of-life care.
The 2022 CDC Clinical Practice Guideline is intended to help clinicians weigh the benefits and risks of opioids and alternative pain treatments for outpatients. The new guideline addresses the following 4 key areas: 1) determining whether to initiate opioids for pain; 2) selecting opioids and determining opioid dosages; 3) deciding duration of initial opioid prescription and conducting follow-up; and 4) assessing risk and addressing potential harms of opioid use.
According to new findings from a systematic review, nonopioid therapies were found to be at least as effective as opioids for common types of acute pain. The new guideline recommends that clinicians maximize the use of nonopioid therapies for acute pain as appropriate and consider opioid therapy only if the potential benefits outweigh the risks. Moreover, clinicians are urged to avoid unintentional long-term opioid treatment for patients receiving opioids for subacute pain without carefully reassessing the benefits and risks.
Additionally, the guideline includes a new recommendation to help clinicians determine whether and how to taper patients who are already receiving opioids. Clinicians are advised to carefully weigh the benefits and risks of tapering to the benefits and risks of continuing opioids. Because abrupt discontinuation of opioids is not recommended, the CDC notes that tapering dosages by 10% per month or slower for patients who have been taking opioids for at least 1 year will most likely be better tolerated.
The guideline also addresses how social determinants of health influence the care provided. “The science on pain care has advanced over the past 6 years,” said Debbie Dowell, MD, MPH, chief clinical research officer for CDC’s Division of Overdose Prevention. “During this time, CDC has also learned more from people living with pain, their caregivers, and their clinicians. We’ve been able to improve and expand our recommendations by incorporating new data with a better understanding of people’s lived experiences and the challenges they face when managing pain and pain care.”
The entire clinical practice guideline is available here.
- Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR. Recomm Rep 2022;71(No. RR-3):1–95. doi:http://dx.doi.org/10.15585/mmwr.rr7103a1
- Dowell D, Ragan KR, Jones CM, et al. Prescribing Opioids for Pain — The New CDC Clinical Practice Guideline. N Engl J Med. Published online November 3, 2022. doi:10.1056/NEJMp2211040
- CDC releases updated clinical practice guideline for prescribing opioids for pain. News release. November 3, 2022. https://www.cdc.gov/media/releases/2022/p1103-Prescribing-Opioids.html
This article originally appeared on MPR