Choosing Wisely:

Don’t provide long-term opioid therapy for chronic non-cancer pain in the absence of clear and documented benefits to functional status and quality of life.

Rationale and Comments: Long-term use of opioids is common in the post-acute and long-term care setting. The Society’s 2018 Position Statement on the use of opioids states that nursing home practitioners who prescribe opioids should do so based on thoughtful interprofessional assessment indicating a clear indication for opioid use. For admitted residents on long-term opioid therapy for chronic pain (not for cancer, palliative care, or end-of-life), tapering plans should be individualized and should minimize symptoms of opioid withdrawal while maximizing pain treatment with non-pharmacologic therapies and non-opioid medications. Periodic review to evaluate risk factors for potential harms should be incorporated into the individualized plan of care. In addition, clinicians should offer alternative behavioral therapies, non-opioid analgesics, and other non-pharmacologic treatments whenever available and appropriate.
Sponsoring Organizations:
  • Society for Post-Acute and Long-Term Care Medicine
  • Sources:
  • Centers for Disease Control and Prevention
  • Disciplines:
  • Geriatric Medicine
  • Neurologic
  • References: • Chou R, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162(4):276-286.
    • Dowell D, et al. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49.
    • Pimentel CB, et al. New initiation of long-acting opioids in long-stay nursing home residents. J Am Geriatr Soc. 2016;64(9):1772-1778.
    • Hunnicutt JN, et al. Prevalence of long-term opioid use in long-stay nursing home residents. J Am Geriatr Soc. 2018;66(1):48-55.
    • Fain KM, et al. Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain. J Am Geriatr Soc. 2017;65(2):286-293.
    • Kaldy J. PALTC practitioners step up to address opioid crisis. Caring for the Ages. 2019;20(4):19.
    • Berna C, et al. Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice. Mayo Clin Proc. 2015;90(6):828-842.

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