About This Site

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, 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.

Methods

CDC conducted literature searches to identify clinical guidelines related to opioid prescribing. Specifically, in 2018, we 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 (Mikosz et al). 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. The acute pain conditions included on this site and their associated recommendation statements are listed in alphabetical order.

Optimize Benefits While Minimizing Risks

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. 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 use[1] and that the number of opioid refills and cumulative milligrams [in morphine milligram equivalents (MMEpdf icon)] of opioids initially prescribed for opioid-naïve patients was associated with long-term use.[2]
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.

[1] 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.
[2] 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