This webpage provides a high-level overview of The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline). For in-depth information and implementation considerations, please read the full guidance.
The 2022 Clinical Practice Guideline includes information that updates and replaces the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.
The recommendations do not apply to pain management related to sickle cell disease, cancer-related pain treatment, palliative care, or end-of-life care.
The 2022 Clinical Practice Guideline broadens the scope from primary care physicians to include additional clinicians whose practice areas include prescribing opioids in outpatient settings (upon discharge from hospital, emergency departments, and other facilities) for patients 18 years or older.
- Family physicians
- Nurse practitioners
- Physician assistants
- Dental and other oral health clinicians
- Emergency clinicians providing pain management for patients being discharged from emergency departments
- Occupational medicine physicians
- Physical medicine and rehabilitation physicians
- Obstetricians and gynecologists
The 2022 Clinical Practice Guideline refers to and promotes integrated pain management and collaborative working relationships among clinicians, including, for example, behavioral health specialists such as social workers or psychologists, pharmacists, and registered nurses.
These five guiding principles are intended to inform the implementation of the 2022 Clinical Practice Guideline recommendations:
- Acute, subacute, and chronic pain needs to be appropriately assessed and treated independent of whether opioids are part of a treatment regimen.
- Recommendations are voluntary and are intended to support, not supplant, individualized, person-centered care. Flexibility to meet the care needs and the clinical circumstances of a specific patient is paramount.
- A multimodal and multidisciplinary approach to pain management attending to the physical health, behavioral health, long-term services and supports, and expected health outcomes1 and well-being of each person is critical.
- Special attention should be given to avoid misapplying this clinical practice guideline beyond its intended use or implementing policies purportedly derived from it that might lead to unintended and potentially harmful consequences for patients.
- Clinicians, practices, health systems, and payers should vigilantly attend to health inequities; provide culturally and linguistically appropriate communication, including communication that is accessible to persons with disabilities; and ensure access to an appropriate, affordable, diversified, coordinated, and effective nonpharmacologic and pharmacologic pain management regimen for all persons.
1The terminology “expected health outcomes” refers to what is expected to happen based on an individual’s health/medical conditions.
The 2022 Clinical Practice Guideline includes guidance on prescription opioids for acute pain (duration less than 1 month). Nonopioid therapies are at least as effective as opioids for many common types of acute pain, including but not limited to low back pain, neck pain, pain related to other musculoskeletal injuries (such as sprains, strains, tendonitis, bursitis), and pain related to minor surgeries. Additional recommendations and implementation guidance can be found in Recommendation 1.
The 2022 Clinical Practice Guideline includes content on management of subacute pain (duration of 1-3 months). Critical opportunities to reassess a patient’s prescriptions during the subacute time frame are highlighted to ensure that opioid prescribing for acute pain does not unintentionally become long-term opioid therapy.
The guidance aims to clearly delineate recommendations that apply to patients who are:
- Being considered for initial treatment with prescription opioids, or
- Already receiving opioids as part of their ongoing pain management.
More information about opioid therapy as it relates to these two patient categories is available. Visit CDC’s Initiating Opioid Therapy and Continuing Opioid Therapy web pages.
The benefits and the risks of opioid therapy change over time and should be re-evaluated periodically (Recommendations 6 and 7). Recommendation 5 outlines situations when clinicians should consider tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy and that these approaches should be discussed with patients prior to initiating changes. Recommendation 5 also includes revised and expanded guidance on the following key topics to support opioid tapering when indicated:
- Determining whether, when, and how to taper opioids
- Providing advice to patients prior to tapering
- Pain management during tapering
- Behavioral health support during tapering
- Tapering rate
- Management of opioid withdrawal during tapering
- Challenges to tapering
- Continuing high-dosage opioids
The recommendations related to opioid dosages are not intended to be used as an inflexible, rigid standard of care; rather, they are intended to be guideposts to help inform clinician-patient decision-making.
Opioid dosage guidance was updated regarding:
- Suggestions for the lowest starting dose for opioid-naïve patients.
- Morphine milligram equivalent doses for commonly prescribed opioids.
- The approach to potential dosage increases, emphasizing principles of safe and effective pain treatment that allow for individual circumstances and flexibility in care.
These recommendations apply specifically to starting opioids or to increasing opioid dosages, and a different set of benefits and risks applies to reducing opioid dosage. Specific considerations to inform clinical decision-making and individualized patient care can be found in the supporting text of the recommendations.
All patients with pain should receive treatment that provides the greatest beneﬁts relative to risks. This includes consideration of nonopioid therapies. The 2022 CDC Clinical Practice Guideline has expanded guidance on nonopioid options for pain such as:
- Topical or oral non-steroidal anti-inﬂammatory drugs (NSAIDs)
- Immobilization and/or exercise
The 2022 Clinical Practice Guideline describes evidence about long-standing health disparities that exist in the treatment of pain, such as geographic disparities and disparities in treatment due to access and affordability. It also highlights the importance of attention to health inequities related to race and ethnicity, as a guiding principle for implementation.
For more information about these topics, read the full 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain.