On November 3, the CDC released a comprehensive document updating and expanding its guidelines on how and when clinicians should prescribe opioids for pain.
The update is the first since 2016 and addresses four key areas:
- Determining whether to initiate opioids for pain
- Selecting opioids and determining opioid dosages
- Deciding duration of initial opioid prescription and conducting follow-up
- Assessing risk and addressing potential harms of opioid use.
The 2022 Clinical Practice Guideline for Prescribing Opioids for Pain includes 12 comprehensive recommendations for clinicians prescribing opioids for adults with acute pain lasting less than a month, subacute pain lasting one to three months, and chronic pain lasting more than three months, excluding pain management related to sickle cell disease, cancer-related pain treatment, palliative care, and end-of-life care.
The rationale for the update, as stated within the document, is that “since the release of the 2016 CDC Opioid Prescribing Guideline, new evidence has emerged on the benefits and risks of prescription opioids for both acute and chronic pain, comparisons with nonopioid pain treatments, dosing strategies, opioid dose-dependent effects, risk mitigation strategies, and opioid tapering and discontinuation.”
In a statement, Debbie Dowell, MD, MHP, chief clinical research officer for CDC’s Division of Overdose Prevention, reiterated the rationale, saying, “The science on pain care has advanced over the past six years. During this time, CDC has also learned more from people living with pain, their caregivers, and their clinicians. 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.”
The revised guideline also notes that although some laws, regulations, and policies that appear to support recommendations in the 2016 guideline might have had positive results for some patients, some policies purportedly drawn from it have been "notably inconsistent ... and have gone well beyond its clinical recommendations," with misapplications ranging from rigid application of opioid dosage thresholds to patient dismissal and abandonment.
Such misapplications "have contributed to patient harm, including untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and suicidal ideation and behavior," the 2022 document states.
The update comes at a point in dentistry where numerous studies have pointed to the efficacy of prescribing NSAIDs for dental pain. In December, for example, a single dose study by Bayer Consumer Health Division found that in treating moderate-to-severe postsurgical dental pain, a single dose of nonprescription naproxen sodium 440 mg (NapS) was at least as effective through hour four post-surgery and better tolerated than a single dose of an opioid combination of hydrocodone plus acetaminophen.
Within the update, recommendation 1 states that “Nonopioid therapies are at least as effective as opioids for many common acute pain conditions, including low back pain, neck pain, pain related to other musculoskeletal injuries (e.g., sprains, strains, tendonitis, and bursitis), pain related to minor surgeries typically associated with minimal tissue injury and mild postoperative pain (e.g., simple dental extraction), dental pain, kidney stone pain, and headaches including episodic migraine.”
Access the full CDC update: 2022 Clinical Practice Guideline for Prescribing Opioids for Pain