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Cited by 2,697Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

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Dowell, Deborah, Haegerich, Tamara M., Chou, Roger·2016·MMWR. Recommendations and Reports
DOI 10.15585/mmwr.rr6501e1
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Abstract

This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death. CDC has provided a checklist for prescribing opioids for chronic pain (http://stacks.cdc.gov/view/cdc/38025) as well as a website (http://www.cdc.gov/drugoverdose/prescribingresources.html) with additional tools to guide clinicians in implementing the recommendations.

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  • Patients treated by DOs more often reported low back pain management in accord with current clinical practice guidelines, including greater use of nonpharmacologic treatments (eg, spinal manipulation) and lesser use of NSAIDs and opioids, than patients treated by MDs.

    “Our findings demonstrate that patients treated by DOs more often reported low back pain management that was in accord with current clinical practice guidelines, including greater use of nonpharmacologic treatments (eg, spinal manipulation) and lesser use of NSAIDs and opioids, than patients treated by MDs.”

    From <b>Empathy in Medicine</b> Osteopathic and Allopathic Physician Interpersonal Manner, Empathy, and Communication Style and Clinical Status of Their Patients: A Pain Registry–Based Study (2019) · cites this paper as [23]

    The Recommendations section supports nonpharmacologic treatment for chronic low back pain, and the guideline cautions against long-term opioid use for that condition. But the Effectiveness of Nonpharmacologic and Nonopioid Pharmacologic Treatments section says NSAIDs are recommended as first-line treatment for low back pain; it does not establish that less NSAID use is more guideline-concordant or specifically recommend spinal manipulation. The DO–MD comparison is presented as the citing authors’ own finding, not as a finding of this guideline. (LLM, conf=0.88)

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  • The Centers for Disease Control and Prevention and other stakeholders have promulgated recommendations to shift healthcare systems away from opioid-centric chronic pain management toward multimodal treatment paradigms promoting evidence-based nonpharmacologic treatments.

    “the Centers for Disease Control and Prevention and other stakeholders have promulgated recommendations seeking to shift healthcare systems away from opioid-centric chronic pain management and towards multimodal treatment paradigms where evidenced-based nonpharmacologic treatments are promoted.”

    From A Research Agenda for Advancing Non-pharmacological Management of Chronic Musculoskeletal Pain: Findings from a VHA State-of-the-art Conference (2018) · cites this paper as [3]

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Research works printed but not linked: 3

  1. Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011.
  2. Institute of Medicine. Dying in America: improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press; 2015.
  3. Paone D, Dowell D, Heller D. Preventing misuse of prescription opioid drugs. City Health Information 2011;30:23-30. 196. Thorson D, Biewen P, Bonte B, et al. Acute pain assessment and opioid prescribing protocol. Bloomington, MN: Institute for Clinical Systems Improvement; 2014. https://www.icsi.org/_asset/dyp5wm/Opioids.pdf 197.

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Authors
Dowell, D., Haegerich, T. M., & Chou, R.
Affiliations
National Center for Injury Prevention and Control (US)
ORCID
Venue
MMWR. Recommendations and Reports
Publisher
Centers for Disease Control MMWR Office
Published
2016-03-18
Volume
65
Issue
1
Pages
1-49
ISSN
  • 1057-5987 (ISSN-L)
  • 1545-8601
DOI
10.15585/mmwr.rr6501e1
OpenAlex
W2920592781
Cited by
2,697
References
197
Citations by year
2026: 82 · 2025: 102 · 2024: 144 · 2023: 210 · 2022: 290 · 2021: 349 · 2020: 381 · 2019: 382 · 2018: 347 · 2017: 297 · 2016: 110 · 2015: 1 · 2014: 1
FWCI
373.31
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • MMWR Recommendations and Reports (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
opioid prescribing, chronic pain, opioid use disorder, opioid overdose, opioid-related deaths, opioid risk assessment, primary care, overdose prevention
MeSH terms
Adult, Analgesics, Opioid, Centers for Disease Control and Prevention, U.S., Humans, Drug Prescriptions, Primary Health Care, United States, Randomized Controlled Trials as Topic, Risk Assessment, Chronic Pain, Prescription Drug Misuse, Observational Studies as Topic

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