Chronic pain and prescription opioid misuse are both major public health problems that exist across the continuum of care. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. The CPPM aim to identify and promote the essential elements of acute, chronic and palliative pain assessment and management for both children and adults, as well as recognize the risks of opioid use disorder. The revised complete pain toolkit aligns with national guidelines and aim to help clinicians meet federal and state regulations.
Improving the way opioids are prescribed through clinical practice guidelines can ensure seriously ill patients have access to safe and effective chronic pain treatments, while reducing the number of people who misuse or overdose from these drugs. Drug overdose deaths and opioid-involved deaths continue to increase in the United States. Deaths from drug overdose are up among men and women, all races, and adults of nearly all ages.
It is essential to establish and focus treatment on patient specific SMART (Specific, Measurable, Agreed Upon, Realistic, Time-based) goals that result in improved function and quality of life and reduction in suffering. All patients should be engaged in active management of their pain (active approach.) Because chronic pain affects the whole person (body, mind, and spirit), patient-centered nonpharmacologic therapies that acknowledge the patients’ roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective.
When opioids are indicated, treatment should be based on the patient’s goals and combined with an active nondrug approach and & nonopioid pharmacologic therapy, as indicated. A written treatment plan should be developed and documented in the medical record and reviewed periodically, at least annually, using a risk/benefit analysis.
Treatment plans must include the goals for pain management and functional improvement based on the patient’s diagnosis. A full discussion of how this opioid treatment will be tapered to lower doses or tapered and discontinued, if benefits do not outweigh the risks, is required. The prescriber must also advise the patient of alternatives to and the risks of alternatives to opioids (informed consent is a discussion of the risks/benefits/alternatives including the alternatives, no treatment, and risks of alternatives). When opioids are indicated, a Pain Management Agreement and Informed Consent should be used.
Continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety. If benefits do not outweigh harms of continued opioid therapy, optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids. Avoid abrupt cessation of opioids.
Additional information is found on Pain Guidelines, Opioid Use Disorder, Patient Resources and Help with Addiction.