Guidelines for Prescribing Opioids for Chronic Pain

Introduction

In order to prevent misuse, abuse, or overdose from Opioids for chronic pain treatment, CDC (Centers for Disease Control and Prevention) improved clinical practice guidelines. These recommendations ensure patients have access to safer and more effective chronic treatment. Around 2 million Americans, above 12 or older aged, either abused or were dependent on prescription Opioids in 2014.

• Survey shows that 11% of adults experience daily pain
• Millions of Americans are treated with prescription Opioids for chronic pain
• Primary care providers are concerned about patient addiction and report insufficient training in prescribing Opioids.

The following recommendations help in determining when to initiate or continue Opioids for chronic pain.

1. Physicians should perform Opioid therapy to get benefits of pain and function without any risk to the patient. Opioids should be used in combination with non-pharmacologic therapy and non-Opioid pharmacologic therapy for treatment of chronic pain.
2. Clinicians should tell about risks and treatment goals like pain and function before going to start Opioid therapy for chronic pain and aware the patients how to discontinue Opioid therapy without any risks.
3. During entire Opioid therapy, clinicians and patients should discuss risks, benefits of Opioid therapy and responsibilities for managing therapy.
4. Once the Opioid therapy started, physicians prescribe immediate-release Opioids instead of extended-release/long-acting (ER/LA) Opioids.
5. Prescription of low dosage of Opioids is mandatory. Clinicians should consider evidence of individual benefits and risks while prescribing Opioids increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and dosage should not increase more than ≥90 MME/day or take a decision carefully to titrate dosage to ≥90 MME/day.  
6. For the treatment of acute pain long-term Opioid can be advisable. Clinicians must prescribe lowest effective dose of immediate-release Opioids. The quantity should not exceed and medication should be three days or less sufficient, more than seven days very rare for continuation.
7.  Once the Opioid therapy started for chronic pain benefits and harms must be evaluated within 1 to 4 weeks and evaluation should be done for every 3 months or more frequently. If there is no any side effects observed, physicians should diminish other therapies and reduce the dosage or discontinue the Opioids.
8. Evaluate risk factors for Opioid related harms and incorporate into the management plan strategies to mitigate risks.
9. Physicians should review patient’s history from state prescription drug monitoring program (PDMP) to avoid the risks of over dosage from Opioids. Clinicians should review PDMP data of patient’s Opioid therapy prescription for every three months.
10. Urine drug testing should be performed before starting Opioid therapy to assess for prescribed medications and other illegal drugs.
11. Avoid frequent prescribing Opioid pain medication and benzodiazepines.
12. Physicians should offer or arrange treatment for Opioid treatment disorder if necessary.

Opioid therapy, chronic pain, extended release opioids