One of the biggest challenges in medical practice is the treatment of chronic pain. Pain affects the lives of millions of Americans and potentially reduces their level of function, mental health, and quality of life. Yet limited access to pain treatments and lack of clarity regarding the evidence supporting pain treatments prevent many people with pain from accessing the full range of potentially helpful therapies. Furthermore, there are persistent disparities in pain management according to race or ethnic group, gender, socioeconomic status, and population density, among other factors. Opioids continue to be commonly used to treat pain, despite evidence that their short-term benefits are small and despite limited evidence of long-term benefits.

In 2016, the Center for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain to help primary care clinicians weigh benefits and risks of opioid treatment for chronic pain. The guideline’s release was associated with accelerated reductions in overall and potentially high-risk prescribing of opioids and with increases in prescribing of nonopioid pain medications. However, this guideline was not fully implemented, and was also the origin of some misunderstanding. Hence a new guideline was published in 2022 which “aims to promote equitable access to effective, informed, individualized, and safe pain management that improves patients’ function and quality of life, while clarifying and reducing the risks associated with opioid use. Ideally, new recommendations should result in greater and more equitable access to the full range of evidence-based treatments for pain, more judicious initial use of opioids, and more careful consideration and management of benefits and risks associated with continuing, tapering, or discontinuing opioids in patients who are already receiving them long term. The CDC will monitor for these intended effects as well as for unintended effects and will work with public and private payers and share evidence that can be used to inform decisions regarding coverage for a broader range of pain therapies. Evidence to guide the best achievable pain management remains limited, and research should address critical remaining gaps, including long-term comparative effectiveness of therapies for pain. Patient–clinician communication about benefits and risks associated with opioids remains central to treatment decisions. The 2022 guideline can help inform those decisions and assist clinicians in meeting patients’ unique needs.”1

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References

  1. Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). Prescribing Opioids for Pain — The New CDC Clinical Practice Guideline. New England Journal of Medicine, 387(22), 2011–2013. https://doi.org/10.1056/nejmp2211040

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