Committed to fighting the opioid overdose epidemic, the Centers for Disease Control and Prevention (CDC) helps support states and communities through monitoring trends, research, supporting providers and healthcare systems, as well as increasing public awareness. Recently, the CDC updated its Clinical Practice Guideline for Prescribing Opioids for Pain, originally released in 2016, with renewed emphasis on non-opioid alternatives and increased focus on the collaboration of healthcare providers to provide safe and effective treatment for adults with acute, subacute and chronic pain.
“In general, the new guidelines create an improved framework for clinicians to help empower consumers to make informed decisions about their pain management, that takes into consideration the risks versus benefits of using opioids for long-term pain management,” says Brian Couey, Psy.D., executive director of INTEGRIS Health Arcadia Trails Center for Addiction Recovery in Edmond. “This is a great step that aligns with both the primary prevention pillar of the HHS Overdose Prevention Strategy, and brings the clinical research on chronic pain over the last decade to the forefront of clinical practice.”
Couey says there’s more evidence-based pain management strategies, which are now proven, that were not widely in use in previous decades.
“This includes psychological interventions, such as cognitive-behavioral therapies to decrease pain perception; exercise and physical therapy techniques; non-opioid medications which can also treat pain, such as certain medications for depression and seizures; injection therapies; weight loss; acupuncture and many others,” he says. “Chronic pain is a complex issue that involves more than using one option, especially an option that comes with the risks of using opioids.”
Management and Tapering
Krishna Vedala, M.D., an internal medicine physician with Norman Regional Health System, says the updated CDC guidelines don’t necessarily change how physicians currently practice, but instead offer more compassion.
“The reason I say that is because one of the areas that the CDC guideline addresses is the need to be cautious and careful when tapering down the dosage for someone currently taking opioids,” he says. “It has to be done appropriately to ensure the patient doesn’t suffer withdrawal effects.”
The updated CDC guidelines include revised and expanded recommendations involving tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy.
“The intention, of course, is for opioids to only be prescribed when necessary and for the management of a patient’s care to be closely supervised by a physician,” says Vedala. “There are limited indications for a chronic prescribed medication, and these are typically managed by pain medicine specialists and/or oncologists.”
Tackling Chronic Pain
When considering the effects of the CDC 2016 guideline within the healthcare community, Couey believes it brought awareness to the complexity of treating chronic pain and encouraged a more multidisciplinary approach to pain management.
“At the forefront of this shift was a recognition that treatment does not only need to attend to the physical manifestations of pain, but encouraged a critical view that considers other influences such as behavioral health, long-term structures and supports, and expected health outcomes from an individualized well-being perspective,” he says.
This intentional patient-centered approach is meant to encourage the treatment of the whole person.
“As providers, we’re trying to incorporate more behavioral health into our daily routine,” says Vedala. “Even our clinical care coordinators are now being assigned to reach out to any patient in which we’re concerned about potential substance abuse. We try to make contact and see if there’s any resources available that can assist them.”