Pain Management and Opioid Abuse
Challenges of Pain Management
Chronic pain management is a public health concern with significant increases in the use of opioids for pain relief. There is a corresponding growth in the number of opioids prescribed in the U.S. and the overdose from those drugs.1,2,3 Family physicians and other primary care providers play a vital role in balancing patients’ pain management needs with the risk of drug misuse and abuse.
The American Academy of Family Physicians (AAFP) is dedicated to finding solutions to the crisis of pain management and opioid abuse. We recognize that long-acting and extended-release opioids are powerful drugs that require oversight, but these drugs can be controlled without unduly limiting their proper use. Creating additional prescribing barriers for primary care physicians would limit patient access when there is a legitimate need for pain relief.
Treating Patients with Chronic Pain
Patients with chronic pain will often initially consult their family physician for treatment. Treatment may include subspecialists, but it is often the family physician’s role to coordinate and manage care, including the use of opioid pain relievers. The AAFP views the goal of pain management to be primarily improvement and maintenance of function. We urge family physicians to individualize treatment based on a review of a patient’s potential risks, benefits, side effects, and functional assessments, and to monitor ongoing therapy accordingly.
The AAFP, in conjunction with the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, and the Society of Teachers of Family Medicine, developed guidance to teach residents how to care for patients with chronic pain. Skills suggested include:
- Understanding the pathophysiology of chronic pain
- Evaluating a patient’s opioid abuse risk utilizing risk assessment tools
- Establishing opioid contracts with patients
- Interpreting urine toxicology screens
- Performing chart reviews and adjusting treatment plans based on those reviews
- Treating and monitoring patients at high risk of abuse
- Prescribing narcotic alternatives
- Performing selected joint injections
The AAFP will continue to be an active participant in issues concerning pain management and opioid abuse through advocacy, collaboration, and education. Use the resources on this page and on our healthy interventions page to guide your patients through pain management issues.
Healthy Interventions Pain Management & Opioid Abuse Resources
Gain access to valuable information and tools to help your practice and community address pain management and opioid abuse issues.
Family Medicine-Oriented Patient Education on FamilyDoctor.org
Read AAFP Policies & Papers
AAFP Position Paper
AAFP's position paper, Pain Management and Opioid Abuse: A Public Health Concern (15-page PDF), includes AAFP advocacy, clinical, continuing medical education, and collaboration recommendations.
AAFP Encourages Widespread Access to Naloxone: With the support of the AAFP, the American Medical Association Task Force to Reduce Opiod Abuse strongly encourages widespread access to Naloxone.
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Access Journal Articles
From Family Practice Management (FPM)
From Annals of Family Medicine
- Opioids for Chronic Noncancer Pain: As the Pendulum Swings, Who Should Set Prescribing Standards for Primary Care?(www.annfammed.org)
Review Related Articles
- Stop the Stigma and Expand Access to Comprehensive Treatment(www.ama-assn.org): The AMA Task Force to Reduce Opioid Abuse believes it’s up to America’s physicians, patients and policymakers to help stop the stigma of substance use disorders.
- NIH's Draft National Pain Strategy: Academy strongly supports more physician education on pain treatment.
- Providers' Clinical Support System for Opioid Therapies (PCSS-O) Modules(pcss-o.org): Free, non-CME opioid training modules, developed in cooperation with the AAFP.
- National Institute for Drug Abuse (NIDA) Addiction Performance(www.drugabuse.gov): This online tool, developed in cooperation with the AAFP, may help you identify and help drug-abusing patients.
- Opioid Studies Mark Slowdown in Abuse, but Work Remains: More research is need to fine-tune prescribing practices to combat abuse.
- Many Physicians Leery of Using Opioids for Noncancer Pain: Even though opioid abuse rates across the United States are still sky-high, it appears progress is being made on the physician end of the supply chain.
AAFP's Dr. Wergin on Pain Management
Past AAFP president and current board chair, Robert Wergin, MD, FAAFP, was featured in a 2016 New York Times article about the complexities and challenges family physicians face when treating patients with chronic pain.