Addressing Pain

CDC releases guideline for PCPs on prescribing opioids for chronic pain

The recommendation urges health care professionals to use non-opioid therapies for chronic pain, ‘start low and go slow’ when prescribing opioids, and monitor patients regularly.


The U.S. Centers for Disease Control and Prevention issued new guidance urging primary care physicians to treat chronic pain with opioids only as a last resort. The guideline, which aims to address the U.S. opioid abuse epidemic, isn’t binding, but the New York Times reports that it’s likely to have a significant impact on medicine all the same.

The AOA has been active in seeking solutions to the opioid epidemic, partnering with the White House, the U.S. Department of Health and Human Services (HHS), the AMA Task Force to Reduce Opioid Abuse as well as a work group convened by the National Association of Boards of Pharmacy, which facilitates collaboration between physicians and pharmacists in an effort to ward off abuse of opioids.

‘DOs are uniquely situated to treat pain’

Stephen M. Scheinthal, DO, is a psychiatry professor at the Rowan University School of Osteopathic Medicine in Stratford, New Jersey, and serves as the AOA’s representative on the AMA Task Force to Reduce Opioid Abuse. He’s hopeful that the new CDC guidelines will spark national conversation and increase consumers’ awareness of the risk of becoming addicted to opioids.

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“As osteopathic physicians, we’re very concerned about public health and disease prevention, so we’re excited this message is getting a broader audience,” Dr. Scheinthal says. He also notes that DOs’ osteopathic training makes them particularly well-suited to treating patients with chronic pain. “DOs are uniquely situated to treat pain, both through manipulative techniques that alleviate discomfort and because we take a holistic view of the components that can affect pain, which include mental, social, physical and environmental factors,” Dr. Scheinthal says.

Guideline recommendations

In contrast to previous safety tips, which focused on minimizing risk for high-risk patients, the CDC’s new guideline acknowledges that “opioids pose risk to all patients.” As such, it recommends primary care health professionals:

  • Use non-opioid options to help with pain, such as exercise, cognitive behavioral therapy, and non-opioid painkillers such as aspirin or ibuprofin.
  • Start with the lowest possible effective dose of opioids, and use immediate-release opioids rather than extended-release/long-acting opioids. Don’t prescribe more medication than the patient is expected to need.
  • Monitor and follow up with patients to be sure prescribed opioids are treating pain effectively and are not causing harm.

To learn more, read the CDC’s March 15, 2016, guideline on prescribing opioids for chronic pain. The AOA continues a healthy dialogue with the CDC about the benefits of the osteopathic approach to pain.

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