Practice Guidelines

Management of Chronic Pain and Opioid Misuse: A Position Paper from the AAFP


Key Points for Practice

• Physicians should provide patient-centered care, including coordinating with other disciplines, to patients with chronic pain or dependence on opioids.

• Practices should encourage their physicians to use medication-assisted treatment options for patients with opioid dependence.

• Physicians are encouraged to use their state prescription drug monitoring programs for tracking purposes, to identify abuse or diversion, and recognize persons who might be at risk.

• Methadone, buprenorphine, and naltrexone are used as opioid substitutes in medication-assisted treatment.

From the AFP Editors

Managing chronic pain and opioid misuse can be challenging. Although data on the risks of opioid use have become clearer, knowledge of the long-term benefits is limited. Overprescribing, misuse, diversion, and dependence have occurred as a result of external pressures, physician behavior, inadequate evidence, and pharmacologic development. Family physicians could play an important role in alleviating these problems; therefore, the American Academy of Family Physicians (AAFP) is committed to ensuring family physicians are a part of the solution.

Call to Action

The AAFP formed an advisory committee to focus on the issues involved in addressing undertreated pain and opioid misuse at a variety of levels, and is calling for action from itself and its members.


Physicians should provide patient-centered care to those with chronic pain or dependence on opioids, and should work with other health care professionals to provide multidisciplinary care. Evidence and guidelines regarding management of chronic pain and opioid dependence should be assessed. It is important to recognize risk factors for overdose or misuse in persons with chronic pain taking opioids, and to properly use prescription drug monitoring programs, drug screening, treatment agreements, or other methods to counter these factors. Obtaining a Drug Addiction Treatment Act of 2000 (DATA 2000)

Author disclosure: No relevant financial affiliations.

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

A collection of Practice Guidelines published in AFP is available at



Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

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Apr 15, 2018

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