In 2016, the Centers for Disease Control and Prevention (CDC) published its Guideline for Prescribing Opioids for Chronic Pain, a comprehensive document designed to give family physicians and other primary care clinicians who prescribe opioids for chronic pain guidance on when to initiate or continue opioids for chronic pain; direction on opioid selection, dosage, duration and discontinuation; and recommendations for assessing risk and addressing harms associated with opioid use.
Since that time, a considerable amount of research has been published on treatments for chronic pain that are noninvasive and nonpharmacological and that do not involve opioids. Based on the new research, the CDC determined that it was necessary to update the guideline and expand it to address certain acute conditions.
As a result, the CDC recently posted an updated draft clinical practice guideline in the Federal Register and invited comments through Monday, April 11.
Guideline at a Glance
Whereas the 2016 guideline focused on the prescription of opioids for chronic pain, the new draft guideline includes categories for patients with acute pain (defined as pain lasting less than one month) and subacute pain (defined as pain lasting one to three months).
In addition, sickle cell disease-related pain management has been added to the list of conditions to which the recommendations do not apply. Previously, the conditions to which the recommendations did not apply were active cancer treatment, palliative care, and end-of-life care.
The new recommendations are for primary care physicians and other health care providers who manage pain in outpatient settings such as clinician offices, clinics, and urgent care centers. They do not apply to inpatient care or to care received in an emergency department (ED) or other observational setting from which a patient might be admitted to inpatient care. The new recommendations do apply to pain management on discharge from an ED, hospital, or other facility.
The American Academy of Family Physicians’ (AAFP) Commission on Health of the Public and Science gave the 2016 guideline its “affirmation of value” designation, agreeing with some recommendations but expressing concerns about others based on the methodology used and a lack of supporting evidence at the time. The Academy reaffirmed the affirmation of value in July 2021.
How to Comment
The AAFP is in the process of submitting comments that will applaud the CDC’s emphasis on unique patient considerations and clinical judgment by physicians in the updated guidelines. The AAFP will also raise concerns about the need to streamline recommendations and clarify evidence standards, among other topics.
Comments, which must be received by Monday, April 11, to be considered, can be submitted electronically or by mail to:
CDC National Center for Injury Prevention and Control
4770 Buford Highway NE, Mailstop S106-9
Atlanta, GA 30341
ATTN: Docket No. CDC-2022-0224
The CDC will revise the draft guideline based on public comments and an independent peer review and is expected to publish a final version of the updated guideline in late 2022.