Guidelines
CDC Guidelines: Prescription for Opioid as treatment for Chronic Pain
These clinical practice guidelines are outlined to promote better results when opioids are prescribed for patients to treat chronic pain. Such guidelines will ensure that patients will have access to safer treatment options and consequently, lowering the risk of substance abuse, overdose, or misuse of chronic pain prescription medication.
In the published guidelines, CDC provided recommendations in prescribing opioid pain medication for patients aged 18 years old and above. The prescription is given when the patient experiences recurring pain sensations lasting longer than the normal duration for tissue healing, which usually spans 3 months, but not including prescriptions for the purpose of hospice and/or palliative care.
For Providers: Opioid Prescription Guidelines
Safety Always Comes First: Prescribe with Care
In the late 90’s, opioid prescriptions have become very common. In fact, nearly 200,000 people lost their lives due to prescription of opioids. Gathering from these statistics, there continues to be a great need for practical and realistic guidelines that will help prescribers promote safer treatments for their chronic pain patients.
Although a lot of people experience chronic pain, not everyone experiences chronic pain in a uniform intensity or degree. Chronic pain can be different from one person to the next. Because of this, deciding on the accurate pain treatment can be difficult for the prescribing physician. The CDC guidelines prove to be essential in treating chronic pain with Opioid.
Objectives of the Guidelines
The guidelines intend to:
- Help prescribers make informed decisions related to chronic pain treatment for primary care patients aged 18 and above.
- Outline the recommendation for using opioids in treating chronic pain which can be categorized as pain that lasts longer than 3 consecutive months.
The guidelines do not apply to patients going through active cancer treatment and hospice care patients. It is important to note that opioids pose a risk that applies to all patients. Because of this, prescribers need to exercise conscientious and responsible decision-making.
Other Treatment Options Not Involving Opioid
Prescribers can turn to non-opioid treatment like exercises and cognitive behavioral therapy. There are also options for pain treatment such as anti-inflammatory medication. Opioids must be combined with nonpharmacologic or non-opioid pharmacologic therapy to promote better results and treatment benefits.
Start with a Low Dose Opioid Therapy
When first prescribing Opioid for a patient, make sure to start with the lowest possible dosage without compromising pain management goals. Ideally, the patient can start with immediate-release opioids as opposed to extended-release/long-acting opioids. Make sure to provide the quantity needed depending on the expected extent or duration of pain.
Check on Your Patients as the Treatment Goes On
Follow-up on your patients as they go through the treatment. See to it that the treatment is improving or alleviating chronic pain to a reasonable degree. Dosage can be adjusted (lowered or increased) as needed to optimize the medication therapy. In some situations, discontinuing the treatment may also be necessary when the risks tied to the treatment will outweigh the benefits.
Guideline Inclusions
It includes clinical practices covering the different aspects of opioid treatment from the dosage requirements, ongoing treatment monitoring, and instances when the treatment needs to be stopped.
1. Deciding when to start, stop, resume or adjust the opioid therapy
- The prescriber can open up about non-pharmacologic therapy as an alternative to opioid treatment.
- The prescriber can then establish the goals of the treatment.
- The prescriber must thoroughly discuss the risks vis-à-vis the benefits of opioid therapy with the patient.
2. Deciding on the type of Opioid treatment
- Choosing between immediate-release or extended-release and long-acting opioids
- Discussing the dosage and its expected effects
- Discussing how long the treatment lasts
- Ensuring follow-up and monitoring with the patient as the treatment goes on
3. Conferring the potential risks and benefits of using opioid to treat chronic pain
- Assessing risk factors for opioid treatment and how those risks can be addressed if they arise
- Prescription Drug Monitoring Program (PDMP) Evaluation
- Urine drug testing
- Weighing in on co-prescribing benzodiazepines
- Discussing possible treatments for health issues that may arise from opioid use
Dosage Recommendations
Recommending the dosage must be done with extreme caution and should be lower than previously published prescription guidelines. The higher the dose, the higher the risk, including but not limited to the potential death of the patient even in as low a dose as 20-50 morphine milligram equivalents (MME) per day.
Considering the Risks of the Treatment
In the previously published guidelines, there were safety precautions specifically for high-risk patients. However, in the current guidelines, it is important to establish that opioids are a risk to all patients who are prescribed with it. Current advances in health care cannot discount the possibility of abuse or misuse. Because of this, the CDC guidelines provide the necessary recommendations for the safety of all patients. The same guidelines also endorse the use of State Prescription Drug Monitoring Programs or PDMP.
Monitoring and Discontinuing
The current guidelines are more specific especially in the monitoring of patients undergoing opioid treatment. It also emphasizes deciding factors on when to discontinue the treatment. In which case, the prescriber can consider collaborating with the patient to reduce the dosage or offering alternatives such as naloxone.
If the patient is taking benzodiazepines with opioids, the prescriber needs to coordinate with other healthcare professionals involved in the patient’s health management. Prescribers need to be aware of the patient’s treatment goals, opioid needs, and the risks involved in opioid treatment. In situations when the patient can potentially develop opioid use disorder, prescribers must be able to comprehensively discuss safety concerns and alternative treatment options.
