From the Guidelines
The CDC 2022 guidelines for the use of opioids and chronic pain management explicitly do not apply to patients with palliative care, sickle cell anemia, and cancer-related pain, but do apply to patients recovering from major trauma once they are past the acute recovery phase. The guidelines specifically exclude patients receiving palliative care, those with sickle cell anemia, and patients with cancer-related pain because these patients often have unique pain management needs that may require higher doses or longer durations of opioid therapy than what would be recommended for general chronic pain management 1. However, for patients recovering from major trauma, the guidelines would apply once they transition from acute to chronic pain management, focusing on using the lowest effective dose, regular reassessment, and consideration of non-opioid and non-pharmacological treatments when appropriate. Some key points to consider when managing pain in patients recovering from major trauma include:
- Using a multimodal approach to pain management, including non-pharmacologic and non-opioid pharmacologic therapies whenever possible 1
- Regularly reassessing the patient's pain and adjusting the treatment plan as needed to ensure that the benefits of opioid therapy outweigh the risks 1
- Considering the use of opioid-sparing strategies, such as regional anesthesia or other interventional procedures, to minimize the need for opioid therapy 1
- Ensuring that patients are aware of the risks and benefits of opioid therapy and are involved in the decision-making process regarding their pain management 1
- Monitoring patients for signs of opioid use disorder and taking steps to mitigate this risk, such as using prescription drug monitoring programs and conducting regular urine drug screens 1.
From the Research
Exceptions to CDC 2022 Guidelines for Opioid Use and Chronic Pain Management
The CDC 2022 guidelines for the use of opioids and chronic pain management have specific exceptions, including:
- Palliative care patients
- Patients with sickle cell disease, as opioids are a critical component of pain relief strategies for these patients 2, 3, 4, 5
- Patients recovering from major trauma or cancer-related pain, as managing cancer pain at the end of life can be challenging, especially in people with current or past substance use disorder 6, 5
Key Considerations for Sickle Cell Disease Patients
For patients with sickle cell disease, opioids are often used to manage acute and chronic pain, and the distinction between acute and chronic opioid management paradigms can be blurred 2. Additionally, opioid management for sickle cell disease is complicated by stigma and concerns regarding addiction 3, 4.
Implications for Palliative Care and Cancer-Related Pain
Palliative care providers must confront stigmas and stereotypes, build knowledge, and assess the risks and benefits of opioids for pain management on an individual basis to provide holistic care for patients with cancer and substance use disorder 6. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations, and clarification and education are needed regarding the intent, patient population, and scope of each guideline 5.