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Am Fam Physician. 2023;108(5):523-526

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• For acute or chronic pain not related to cancer, sickle cell disease, or end-of-life care, consider nonpharmacologic and nonopioid pharmacologic treatments before prescribing opioids.

• Other diagnoses and alternative treatments should be considered before initiating opioid therapy or continuing for more than 30 days.

• When discontinuing opioid therapy, a slow taper can minimize withdrawal symptoms. Slow tapers are often less than 10% of the daily dosage per month, especially after use for one year or more.

From the AFP Editors

Approximately 1 in 14 adults reported having pain that limited their life and work on most days during the past three months. Chronic pain impairs physical functioning, mental health, and quality of life. Nearly 1 in 10 people who commit suicide had evidence of chronic pain at the time of death.

Black, Hispanic, and Asian people are less likely to be assessed or treated for pain. White, American Indian, and Alaska Native people have a higher risk of prescription opioid–related overdose deaths; however, safeguards and monitoring are more often applied to Black patients.

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

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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