Practice Guidelines

CDC Develops Guideline for Opioid Prescribing

 

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Key Points for Practice

• Chronic pain should be managed primarily with nonpharmacologic therapy or with medications other than opioids.

• Physicians should routinely discuss the risks and benefits of therapy and the mutual responsibility to mitigate risk with patients who are receiving opioids.

• When opioids are prescribed, they should be titrated to the lowest effective dosage.

• Treatment should be offered or arranged for patients with opioid use disorder.

From the AFP Editors

Key Points for Practice

• Chronic pain should be managed primarily with nonpharmacologic therapy or with medications other than opioids.

• Physicians should routinely discuss the risks and benefits of therapy and the mutual responsibility to mitigate risk with patients who are receiving opioids.

• When opioids are prescribed, they should be titrated to the lowest effective dosage.

• Treatment should be offered or arranged for patients with opioid use disorder.

From the AFP Editors

Opioids have increasingly been offered to patients in an effort to minimize the substantial impact chronic pain has on daily function. The prevalence of chronic pain among adults in the United States is estimated at approximately 11%, with one report suggesting that the percentage of adults who experience daily pain may be as high as 43%. Since 2007, an upward trend in the number of opioid prescriptions written by primary care physicians has been noted, whereas consensus regarding optimal strategies for treating chronic pain with these potentially harmful medications has remained largely absent.

A recently released guideline aims to establish patient-centered approaches to initiating, managing, and discontinuing opioid use. The recommendations from the Centers for Disease Control and Prevention (CDC) emphasize the serious risks and harms associated with opioids. Long-term studies have not provided rigorous evidence on the effects of long-term opioid use in adults with noncancer pain of at least three months' duration.

Recommendations Based on Higher-Quality Evidence

The CDC advises that chronic pain primarily be treated with nonpharmacologic therapy or with medications other than opioids. The recommendation is based on data from observational studies, as well as randomized clinical trials with notable limitations. Opioids should be considered only if expected benefits are likely to outweigh risks. Nonpharmacologic and nonopioid pharmacologic therapies are recommended as appropriate as part of a regimen to improve pain even if a decision to prescribe opioids has been made.

Because of the adverse effects and risks associated with opioids, patient involvement is critical when initiating or determining whether to continue opioid therapy. Physicians should routinely engage patients who are r

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.


 

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