Treating Pain in an Established Patient: Sifting Through the Guidelines

The CDC Guideline for Prescribing Opioids for Chronic Pain, published last March, provided major steps toward bringing the medical community together to address the opioid epidemic in the U.S. However, the Guideline focuses primarily on treatment of new inductions into opioid therapy for pain. Physicians may have difficulty figuring out how to apply the CDC's recommendations to patients who are already receiving opioid maintenance therapy for chronic pain. Patients already maintained on opioids for chronic pain should not be subjected to abrupt cessation or rapid tapers, and the CDC's Guideline confirms this. Physicians should not balk from treating opioid-dependent patients with chronic pain, and the CDC's recommendations do contain helpful information if one reads through them carefully. This article attempts to distill the major points from the Guideline for the treatment of chronic-pain patients already on long-term opioid therapy.[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].