Avoid using opioids for the treatment of mild, acute pain. For moderate to severe acute pain, if opioids are used, they should be in conjunction with nonopioid methods with the lowest effective dose for the shortest required duration.

Rationale and Comments

Opioids have serious risks, including opioid use disorder and overdose. If opioid therapy is required, pain management with short-acting opioids should be the lowest effective dose for the shortest required duration, often no more than one week. A trial of nonopioid and nonpharmacologic alternatives is recommended for opioid-naïve patients. If opioids are used, they may be used in conjunction with nonopioid methods, when clinically appropriate. For patients already on opioids for chronic pain, it is not recommended to abruptly stop or taper opioid therapy to avoid withdrawal, mental health crisis, and overdose. Individualized treatment plans should be made with the patient and outpatient clinicians, whenever possible. It is important for the clinician to assess potential biases that may affect the treatment of pain.

Sponsoring Organizations

Society of Hospital Medicine – Adult Hospital Medicine

Sources

CDC guideline

Disciplines

Neurologic
Surgical

References

Wood E, Simel DL, Klimas J. Pain management with opioids in 2019-2020. JAMA. 2019;322(19):1912-1913.
Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council [published correction appears in J Pain. 2016;17(4):508-510]. J Pain. 2016;17(2):131-157.
Hachimi-Idrissi S, Dobias V, Hautz WE, et al. Approaching acute pain in emergency settings; European Society for Emergency Medicine (EUSEM) guidelines-part 2: management and recommendations. Intern Emerg Med. 2020;15(7):1141-1155.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016 [published correction appears in MMWR Recomm Rep. 2016;65(11):295]. MMWR Recomm Rep. 2016;65(1):1-49.
Agnoli A, Xing G, Tancredi DJ, et al. Association of dose tapering with overdose or mental health crisis among patients prescribed long-term opioids [published corrections appear in JAMA. 2022;327(7):687, and JAMA. 2022;327(7):688]. JAMA. 2021;326(5):411-419.