Opioids can be used when benefits for pain and function are expected to outweigh the risks of opioid use. When initiating opioid use, clinicians should prescribe and advise opioid use only as needed.
Involve patients in decisions about whether to initiate opioid use, including discussing the benefits and risks of starting or continuing opioid therapy. Whenever opioids are prescribed, clinicians and patients are encouraged to have an "exit strategy" to employ if the treatment is unsuccessful in improving pain and pain-related function, or the risks of opioids outweigh the benefits.
Before initiating opioid therapy, ensure patients are aware of the following factors:
• Expected benefits of opioids
• Common risks of opioids
• Serious risks of opioids
• Nonopioid therapies
Acute pain
Opioid medications can play an important role in treating acute pain (less that 1 month) related to:
• Severe traumatic injuries (including crush injuries and burns)
• Invasive surgeries typically associated with moderate to severe postoperative pain
• Other severe acute pain when nonsteroidal anti-inflammatory drugs (NSAIDs) and other therapies are contraindicated or likely to be ineffective
Clinicians should evaluate patients to assess the benefits and risks of opioids at least every 2 weeks.
When diagnosis and severity of acute pain warrant the use of opioids, clinicians should prescribe:
• Immediate-release opioids,
• At the lowest effective dose, and
• For no greater quantity than needed for the expected duration of pain severe enough to require opioids.
If opioids will be taken continuously (around the clock) for more than a few days, clinicians should create and discuss an opioid tapering plan with their patient.
Subacute and chronic pain
Opioids should not be considered first-line or routine therapy for subacute (1-3 months) or chronic pain (longer than 3 months).
In some situations, opioids might be appropriate regardless of previous nonpharmacologic and nonopioid pharmacologic therapies used. For example, opioids might be appropriate for some patients with serious illness who have a poor prognosis to return to their previous level of function and have contraindications to other treatments. In other situations (e.g., headache or fibromyalgia) the expected benefits of initiating opioids are unlikely to outweigh risks regardless of previous therapies.
Upon initiating opioid use for subacute and chronic pain, clinicians should:
• Evaluate patients and establish or confirm the diagnosis to guide patient-specific selection of opioid therapy.
• Work with patients to establish treatment goals for pain and function.
• Recognize that patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions.
• Consider how opioid therapy will be discontinued if benefits do not outweigh risks.
Nonopioid and nonpharmacologic therapies
Nonopioid therapies are preferred for subacute and chronic pain and are at least as effective as opioids for many common types of acute pain.
Clinicians should maximize the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the patient and specific condition.
https://www.cdc.gov/overdose-prevention/hcp/clinical-care/initiating-opioid-therapy.html