New opioid prescribing guidelines give doctors more leeway to treat pain

New opioid prescribing guidelines give doctors more leeway to treat pain

The Centers for Disease Control and Prevention have issued new guide for doctors on how and when to prescribe opioids for pain. Released Thursday, this is a long-anticipated renewal of the agency’s 2016 recommendations that some doctors and patients have criticized for promoting a culture of austerity around opioids.

Doctors, insurers, and pharmacies have sometimes misapplied the above guidelines, resulting in significant harm to some patients, including “untreated or undertreated pain, severe withdrawal symptoms, worsening pain outcomes, distress psychological, overdose and [suicide],” CDC officials state in the updated guidance.

The 100-page document and its top recommendation serve as a roadmap for prescribers navigating the thorny subject of pain management. It encompasses everything from managing pain relief after surgery to managing chronic pain conditions, which are estimated to affect one in five people in the US.

The 2016 guidelines proved immensely influential in policymaking, primarily a push by insurers, state medical boards, politicians, and federal law enforcement to curb opioid prescribing.

The consequences, doctors and researchers say, are hard to overstate: an untreated pain crisis. In the years that followed, many patients with severe chronic pain saw their long-standing prescriptions reduced or cut altogether, sometimes with dire consequences, including suicide or overdoses, as they turned to the tainted supply of illicit drugs.

The authors of the previous guidelines and federal agencies have tried to correct course, making it clear that the voluntary guidelines were applied incorrectly and were not intended to become strict policies or laws that discourage doctors from prescribing at all. But doctors and patient advocates were also hopeful that the CDC’s updated guidelines would take a more balanced tone on opioids and undo some of the unintended consequences of previous guidance.

This was clearly on the minds of CDC health officials when they announced the new clinical guidelines on Thursday.

“The guideline recommendations are voluntary and are intended to guide shared decision-making between a doctor and a patient,” said Christopher Jones, acting director of the CDC’s National Center for Injury Prevention and Control and co-author of the guidelines. updated guidelines, during a press conference. report, “It is not intended to be implemented as absolute limits of policy or practice by physicians, health systems, insurance companies, government entities.”

The change in perspective is evident in all the new guidelines, says Dr Samer NarouzePresident of the American Society for Regional Anesthesia and Pain Medicine.

“You can tell that the culture around the 2016 guidelines was just to reduce opioids, that opioids are bad,” he says. “It’s the opposite here, you can feel that they care more about patients living with pain. It’s more aimed at relieving pressure, pain, suffering.”

The general thrust of the new guidelines remains that opioids should not be the gold standard treatment in many cases, pointing to evidence that other treatments and approaches are often comparable in improving pain and function. However, much of the prescribing discussion is also tempered by language about not allowing guidance to replace clinical judgment and working with patients who are in pain, even if that means continuing opioids.

“Each patient is a different story and deserves individualized attention,” says Narouze. “This is what I like best about the new guidelines.”

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