CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

Abstract

IMPORTANCE Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category. EVIDENCE SYNTHESIS Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent affects. RECOMMENDATIONS There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. CONCLUSIONS AND RELEVANCE The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Tratamiento con opiodes en dolor crónico no oncológico: Recomendaciones para una prescripción segura

“…Esta situación ha hecho que múltiples sociedades científicas elaboren guías sobre el uso racional de opioides (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Éstas establecen que los pacientes con factores de riesgo de adicción no necesariamente deben ser excluidos de la terapia con opioides si se ha determinado que precisan dicho tratamiento, sino que deben utilizarse después de establecer un plan terapéutico y de monitorización individualizada (15).…”

Power Point Therapy: An Effective and Simple Treatment for Subacute Back Pain – A Randomized Controlled Trial

“…Hence, it has to be considered superior to other types of treatments that need more complicated, time-consuming, and expensive procedures. Considering the fact that pharmacological treatments for chronic pain are discouraged by practically all guidelines because of either potential side effects, as with NSAIDs [50], or the potential for dependence with other substances [51, 52], uncomplicated alternatives such as PPT are most welcome. Our data show that PPT is effective and uncomplicated, as we had no dropouts due to adverse events or other complications.…”

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“…17 Recently, the Centers for Disease Control and Prevention published recommendations based on a systematic review. 15 The recommendations include but are not limited to the following: use opioids only when the benefits are expected to outweigh the risks, reassess the benefits and risks when considering an increase to 50 morphine-equivalents per day, avoid the concurrent use of opioids and benzodiazepines if possible, evaluate the benefits and harms at least every 3 months, and review the prescription drug monitoring program data.…”