Medical person places hand on patient in gesture of reassurance

Clinicians now have updated and expanded guidance for providing pain care using opioid drugs. The new recommendations address care for older adults and those with dementia, among other special populations.

The Centers for Disease Control and Prevention released the guidance on Thursday. Titled CDC Clinical Practice Guideline for Prescribing Opioids for Pain, it is aimed at treatment of adult outpatients with short- and long-term pain. The CDC sought input from patients affected by pain, their clinicians and caregivers as part of a draft guidelines review that began in February.

Individualized care focus

Past prescribing guidance for adults with chronic pain had been interpreted as somewhat inflexible in the context of the opioid epidemic. The authors of the new guidance said that their advice should be seen as voluntary, offering clinicians and patients the support needed to provide “individualized, patient-centered care.”

“The science on pain care has advanced over the past six years,” said Debbie Dowell, MD, MPH, of the CDC’s division of overdose prevention. “During this time … we’ve been able to improve and expand our recommendations by incorporating new data with a better understanding of people’s lived experiences and the challenges they face when managing pain and pain care.”

Poor pain management

Older adults and people with cognitive impairment are two groups that are at risk for inadequately treated pain, the authors noted in the guidance.  Chronic pain often occurs alongside behavioral health conditions, and may increase the risk for suicide, they said.

“These factors and potentially harmful outcomes associated with chronic pain for some persons add to the clinical complexity and underscore the importance of adequately treating and providing care to persons with pain,” they wrote. “Thus, prevention, assessment, and treatment of pain is a persistent challenge for clinicians.”

The updated recommendations replace 2016 guidance, include a section on patients aged 65 years and older, and cover four key clinical decisions:

  • determining whether to initiate opioids for pain;
  • selecting opioids and determining opioid dosages;
  • deciding duration of initial opioid prescription and conducting follow-up; and
  • assessing risk and addressing potential harms of opioid use.

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