title: CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.
abstract: OBJECTIVE
  Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.
  
  
  OBJECTIVE
  To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
  
  
  METHODS
  The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category.
  
  
  RESULTS
  Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects.
  
  
  CONCLUSIONS
  There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone.
  
  
  CONCLUSIONS
  The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Dowell
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Haegerich
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
mesh_terms: D059787:Acute Pain / Q000188:drug therapy; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D059350:Chronic Pain / Q000188:drug therapy*; D003142:Communication; D000075202:Contraindications; D011307:Drug Prescriptions / Q000592:standards*; D004359:Drug Therapy, Combination; D006040:Goals; D006801:Humans; D064887:Observational Studies as Topic; D063487:Prescription Drug Misuse / Q000517:prevention & control; D011320:Primary Health Care / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States; D028761:Withholding Treatment
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines