On Nov. 4, the Centers for Disease Control and Prevention (CDC) released updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, will help clinicians work with their patients to ensure the safest and most effective pain care. The publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain, released in 2016.

The 2022 Clinical Practice Guideline addresses these areas:

• Determining whether to initiate opioids for pain
• Selecting opioids and determining opioid dosages
• Deciding the duration of the initial opioid prescription and conducting follow-up
• Assessing risk and addressing potential harms of opioid use

The CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers and members of the public reviewed a draft of the updated guideline, and the CDC revised it in response to this feedback to foster a collaborative and transparent process.

Mayo Clinic's role in the updated guideline

Mayo Clinic's Enterprise Opioid Stewardship Program helped shape changes to the CDC guidelines, led by Halena Gazelka, M.D., Mayo Clinic Enterprise Opioid Stewardship Program chair. Program members take a multidisciplinary approach to develop and operationalize prescribing guidelines and strategies to enhance patient health, reduce the risk of opioid misuse, and decrease opioid-related impacts and costs.

Fundamental changes to the CDC opioid guidelines include removing 3- and 7- day limits to opioid prescribing for acute pain. The CDC cites research from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery for this change.

"Previously, the day limits were theoretical guidelines used by insurers and states that made them more restrictive, preventing optimal practice in many cases and sometimes leading to underprescribing for a subset of patients, thus causing patient harm," says Elizabeth Habermann, Ph.D., the Robert D. and Patricia E. Kern Deputy Director of Research. "When a patient needs opioids for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids." Dr. Habermann is also a member of the CDC's Board of Scientific Counselors of the National Center for Injury Prevention and Control and its Opioid Work Group.

According to Dr. Gazelka, many changes align with some of Mayo's best practices.

"We do not view opioids as the first line of treatment for chronic pain," says Dr. Gazelka. "If necessary, we start with a lower dose and increase it, as needed to avoid arbitrary dose maximums."

The "pendulum" has swung too far toward restrictive and underprescribing opioids for some patients, explains Dr. Gazelka.

"The COVID-19 pandemic indirectly caused a significant increase in opioid overdoses across the U.S. primarily due to the illicit market of drugs such as fentanyl and not overprescribing in the clinical practice, as was the case previously," she says. "Before 2020, the trend was moving in the opposite direction, as overdoses steadily decreased."

The Mayo Clinic Opioid Stewardship Program continues to take a multidisciplinary approach to develop and operationalize prescribing guidelines and strategies to enhance patient health, reduce the risk of opioid misuse, and decrease opioid-related impacts and costs.

According to the CDC, patient safety and outcomes will continue to improve by equipping health care professionals and patients with the data, tools, and guidance they need to make informed treatment decisions. The 2022 Clinical Practice Guideline supports patients and clinicians in making informed, individualized decisions about safe and effective pain care.

Additional materials associated with the guideline are available for patients and clinicians.

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