Clinical Guidance for Selected Common Acute Pain Conditions

Current Treatment Recommendations from Professional Organizations

The Situation by the Numbers
128

128 Americans die every day from an opioid overdose.footnote1

70%

70% of drug overdose deaths in 2018 involved an opioid.footnote1

232k

232,000 American overdose deaths from Rx opioids from 1999-2018.footnote1

51

51 opioid prescriptions for every 100 Americans.footnote2

Unnecessary opioid prescribing increases patients’ risk of harm

Research shows that opioids are not the most effective treatment for acute pain in nearly all cases, yet the practice persists. As a prescribing healthcare clinician, you play an essential role in mitigating the rising opioid crisis.

Current clinical guidelines recommend effective alternatives that enable clinicians to adequately manage pain and minimize patient risk.

Pill Bottles

Opioids and Acute Pain

Acute pain, often defined as pain lasting 4 weeks or less, may be experienced by patients of all ages due to a variety of different conditions, including post-surgical recovery.footnote3

Optimize Benefits While Minimizing Risk

Decisions regarding pain management should be approached together by a clinician and patient, with the selection of a pain management strategy that optimizes benefits while minimizing risks. Opioid therapy may be considered for management of pain in the acute setting but has well-documented risks. Studies have shown that even just three days of opioid treatment can increase the likelihood of chronic opioid usefootnote4 and that the number of opioid refills and cumulative milligrams [in morphine milligram equivalents (MME)] of opioids initially prescribed for opioid-naïve patients was associated with long-term use.footnote5

This website — and the recommendation statements and materials posted on it — is intended to serve as a reference for clinicians in the management of a number of common conditions associated with acute pain. All recommendations are based on external research and existing published guidelines. Cited recommendations represent current best practices as evaluated by CDC and should not be considered CDC-authored or CDC-endorsed content. The information provided on this website is not intended to be a substitute for the medical judgment of a clinician caring for a specific patient and does not indicate an exclusive course of action or treatment.

Clinicians can learn more about MME from the calculating daily dose fact sheet.pdf icon

Share Decision-Making Between Clinicians and Patients

Importantly, the approach to pain management must ultimately involve a shared decision-making process between clinicians and individual patients. Evidence-based clinical practice guidelines, which are available for some selected common acute pain conditions, can assist clinicians and patients in together making safer, effective pain management decisions. Treatment should be tailored to each individual patient’s pain management goals and consider benefits versus risks for each patient.

Research Methods

CDC conducted literature searches to identify clinical guidelines related to opioid prescribing.

Specifically, in 2018, CDC conducted PubMed and internet searches of publications in the previous 5 years to identify clinical guidelines developed by various stakeholders (e.g., professional societies) addressing the management of acute pain for a select group of common conditions associated with acute pain for which opioids were frequently prescribed.footnote6 Practice-based initiatives currently underway in the field were also identified to develop new recommendations for opioid prescribing directly from such clinical research.

CDC reviewed guidelines to identify key principles for opioid prescribing across common diagnoses and procedures. We reviewed and coded guidelines for key recommendations and for characteristics including whether the guideline was informed by a systematic review of scientific evidence or select scientific studies, whether the recommendations were diagnosis- or specialty-specific, and by the scope of the target patient population (national, state, health system). Guidelines were prioritized for inclusion when recommendations were based on a systematic review of the scientific evidence, included tailoring to specialties, diagnoses/procedures, or patient populations, and were national in scope. Recommendation statements included on this website were selected from larger clinical practice guidelines based on their relevance to the acute pain condition of focus and the management of pain specifically in the acute setting.

[1] Wilson N, Kariisa M, Seth P, et al. Drug and Opioid-Involved Overdose Deaths—United States, 2017-2018. MMWR Morb Mortal Wkly Rep 2020;69:290-297.

[2] U.S. Opioid Prescribing Rate Maps

[3] Postsurgical pain outside of intra-operative pain management.

[4] Shah A, Hayes CJ, Martin BC. Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use — United States, 2006–2015. MMWR Morb Mortal Wkly Rep 2017;66:265–269.

[5] Deyo RA, Hallvik SE, Hildebran C, et al. Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study. J Gen Intern Med. 2017;32(1):21–27. doi:10.1007/s11606-016-3810-3

[6] Mikosz CA, Zhang K, Haegerich T, Xu L, Losby JL, Greenspan A, Baldwin G, Dowell D. Indication-Specific Opioid Prescribing for US Patients with Medicaid or Private Insuranceexternal icon, 2017. JAMA Network Open. 2020;3(5):e204514. doi:10.1001/jamanetworkopen.2020.4514.

Disclaimer

Cited recommendations represent current best practices from professional organizations as evaluated by CDC and should not be considered CDC-authored or CDC-endorsed content, unless expressly stated. The information provided on this website is not intended to be a substitute for the medical judgment of a clinician caring for a specific patient and does not indicate an exclusive course of action or treatment.