Getting a prescription for opiate chronic pain management can be a complicated process. While the CDC guidelines provide a framework for determining whether you qualify for the medication, it is still essential to know your specific medical condition before deciding to begin treatment. Often, people use opioids to treat acute pain, and the long-term use of these drugs is not recommended. Here are a few things to remember when preparing your treatment plan.
Evidence informing the CDC’s guidelines
CDC’s new evidence-based guidelines for opioid chronic pain management aim to provide more effective pain care. The policy provides recommendations to primary care clinicians and outlines the decisions that should be made when prescribing opioids.
The guideline includes four recommendations that aid physicians in their decisions about opioid dosage and duration. It also addresses the use of nonopioid therapies, such as exercise therapy and cognitive behavioral therapy.
The guideline is based on the best available scientific evidence and observational studies. It provides guidelines for the management of acute pain, subacute pain, and chronic pain. It does not apply to palliative care or end-of-life care.
A guideline is a flexible tool that aims to increase physician confidence in managing patients with chronic pain. The policy is intended to reduce the risks of long-term opioid therapy, which can lead to opioid use disorder. However, it is not a replacement for FDA-approved labeling.
The CDC’s guideline includes recommendations for opioid dose reduction. Tapering should be gradual and with psychosocial support. It should include a 10% reduction in the original dosage per week. If the desired effect does not occur, clinicians should consider discontinuing the opioids.
The guideline recommends that clinicians review the patient’s prescription drug monitoring data. In addition, opioids should be monitored for early warning signs of serious adverse events.
The guideline’s recommendations are intended for patients aged 18 and older. It does not apply to cancer or sickle cell disease patients. It also does not cover hospice patients or patients with significant surgical pain.
The recommendations are based on randomized clinical trials and observational studies, with some limitations. These limitations make it challenging to evaluate the quality of the evidence used in the CDC’s guideline recommendations. Nevertheless, the guideline has been lauded by the American Pharmacists Association. The association praised the updated policy as a “significant improvement” over the 2016 guidelines.
While the CDC’s guideline is a good starting point, new evidence is needed to guide treatments better. There are still limitations, such as the lack of sufficient evidence to determine the effectiveness of opioids.
Long-term opioid use often begins with the treatment of acute pain.
Efforts to curb opioid abuse have focused on limiting the supply of new prescriptions. However, there is no consensus on how to prescribe these drugs safely. It is essential to take a patient-centered approach to prescribe opioids.
One strategy is to combine opioids with nonopioid pharmacologic therapy. This is important because opioids are highly addictive. They increase the risk of overdose, dependency, and withdrawal. Using evidence-based programs to identify at-risk patients will help prevent opioid abuse.
While opioids can be helpful in short-term pain relief, long-term use is not advised. Many people become addicted to these medications after they are prescribed for acute pain. In addition, these drugs can have serious side effects, including respiratory depression, constipation, and nausea.
The Centers for Disease Control and Prevention (CDC) updated its systematic review of long-term opioid therapy for chronic pain. This guideline was released on March 15, 2016. This CDC guideline is designed to help clinicians care for patients with noncancer pain, including various other conditions. The guideline contains 12 significant recommendations for using opioids for chronic pain.
The CDC cites a study that found a 6.0% rate of long-term opioid use after a year of therapy. This number is likely inflated by the fact that most people who misuse prescription opioids started using them after a friend or family member gave them to them. The study also noted that the odds of long-term opioid use were increased when the first opioid episode was a day or longer.
Another critical aspect of opioid therapy is the timing of use. Most studies have been conducted on short-term randomized trials. In these trials, the benefits of the medication are small. It is also likely that the effects of the drug will be more pronounced over time.
The CDC recommends prescribing the minimum quantity of opioids necessary to treat the patient’s pain while considering the treatment duration and the medication’s efficacy. It is also prudent to evaluate the effect of the opioid on function. A review of recent studies suggests that opioids do not improve function.
Preparing a treatment plan
During the past decade, the rates of opioid pain medication use have increased, along with the number of people who died from an opioid overdose. In the United States, a total of 165,000 people have died from opioid pain medication overdose, according to the Drug Abuse Warning Network.
CDC has published guidelines for the safe and effective prescribing of opioids for chronic pain. The approach is based on a systematic review of the best available evidence and offers recommendations for the selection of opioids, the duration of therapy, and discontinuation. Its purpose is to improve communication about the risks and benefits of opioids for patients with chronic pain.
The guideline is intended for all primary care clinicians, including physicians, physician assistants, nurse practitioners, and other clinicians. It is also designed to help reduce the risk of opioid overdose.
The guideline includes recommendations for selecting an opioid for a patient, determining the dose and length of therapy, and discussing the risks and benefits of the medication. It also recommends implementing a prescription monitoring program for opioids. It offers additional guidance on tapering and discontinuing opioids and how to dispose of unused drugs.
Clinicians should also consider the risks of opioids, including addiction, overdose, and performance effects when evaluating the benefits and harms of continued opioid therapy. It is also essential to assess the risks of concomitant use of opioids and benzodiazepines.
To assess the effectiveness of an opioid, physicians should consider the patient’s pain severity, cognitive ability, and other factors. They should then tailor the diagnosis and treatment plan to achieve functional goals.
The starting dose of an opioid should be low enough to achieve pain control, but it should be monitored carefully to avoid excessive side effects. When the patient receives a dose of more than 100 milligrams of morphine equivalent per day, the clinician should start tapering the medication.
It is also essential to discuss the risks of addiction, overdose, and the dangers of dependence with the patient. If the patient exhibits any of these symptoms, the clinician should offer naloxone to stop the patient’s use of opioids. It is a good idea to ask the patient to sign an opioid treatment agreement.
Adverse effects of treatment
Using opioids for chronic pain management has its risks. Patients can develop a dependency and addiction, and opioids can have side effects such as overdose, respiratory depression, and other complications. Therefore, clinicians should carefully evaluate the benefits and harms of continuing opioid therapy. Increasing dosages should be carefully assessed as well.
CDC guideline recommendations are based on a systematic review of the best available evidence. The guideline focuses on opioid use for chronic noncancer pain and aims to improve patient outcomes. The procedure is voluntary. A federal advisory committee developed it, the National Center for Injury Prevention and Control Board of Scientific Counselors (BSC). The BSC reviewed the evidence and provided additional input. The CDC sought the advice of experts, stakeholders, and the public on the draft guideline.
The BSC voted to endorse the OGW’s observations and recommended that CDC adopt the recommendations. The BSC also considered the draft guideline and offered an additional public comment period. The final procedures include recommendations for assessing risk and selecting opioids, titration methods, duration of opioid use, and discontinuation of opioids.
The guidelines recommend that opioids be used for pain lasting at least three months. If they are not effective at that point, they should be discontinued. They should be administered under the supervision of a physician. They should be prescribed at the lowest effective dosage. They should not be used in combination with benzodiazepines. They should not be used concurrently with acetaminophen, COX-2 inhibitors, antidepressants, and serotonin reuptake inhibitors.
A review of opioids for chronic pain found that randomized clinical trials had methodological limitations. These included variability in study designs considered “clinical heterogeneity.” However, the review also found some evidence that opioids were moderately effective for pain relief. They were associated with negligible benefits for functional outcomes. There was also some evidence that opioids were associated with opioid use disorder and death.
The authors concluded that the evidence does not support long-term opioid therapy for chronic noncancer pain. There is limited evidence for this practice outside of end-of-life care.
