From the Guidelines
Physical dependence on opioid pain medications can develop after approximately 2-4 weeks of regular use, and the general consensus is that patients should limit continuous opioid use to the shortest duration necessary, ideally less than 7 days for acute pain. According to the CDC clinical practice guideline for prescribing opioids for pain - United States, 2022 1, opioids should not be considered first-line or routine therapy for subacute or chronic pain, and the expected benefits of opioids for chronic pain are small and short-term, with uncertain long-term benefits and potential for serious harms. The development of physical dependence is an expected response for patients treated with opioids over an extended period, but these symptoms typically resolve quickly (3–7 days) 1.
When opioids are needed for longer periods, healthcare providers should reassess the patient regularly and have a clear plan for tapering. Physical dependence occurs when the body adapts to the medication, resulting in withdrawal symptoms upon sudden discontinuation. These adaptations involve changes in neurotransmitter systems, particularly in the brain's reward pathways. Risk factors for developing dependence include higher doses, longer duration of use, and personal or family history of substance use disorders. To minimize dependence risk, patients should use the lowest effective dose, consider multimodal pain management approaches, and follow a gradual tapering schedule when discontinuing opioid medications after prolonged use.
Key considerations for minimizing dependence risk include:
- Using the lowest effective dose
- Considering multimodal pain management approaches
- Following a gradual tapering schedule when discontinuing opioid medications after prolonged use
- Regularly reassessing the patient and having a clear plan for tapering
- Establishing treatment goals, including functional goals, for continued opioid therapy
- Avoiding rapid tapering or abrupt discontinuation of opioids.
It is essential to weigh the benefits of opioid therapy against the risks and to consider alternative treatments, such as nonopioid therapies, which may be preferred for chronic pain due to their lower risk of serious harms 1. Patient education and discussion before starting opioid therapy are critical to ensure that patients are aware of the expected benefits, common risks, serious risks, and alternatives to opioids. Clinicians should review available low-cost options for pain management, be explicit and realistic about expected benefits, and emphasize improvement in function as a primary goal.
From the Research
General Consensus on Ben's Pains
- The general consensus is that Ben's pains may be given for a certain period before physical dependence develops, but the exact duration is not specified in the provided studies.
- According to 2, pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions.
- The studies provided focus on nonpharmacological interventions for acute pain management, pharmacologic therapy for acute pain, and evidence-based nonpharmacologic strategies for comprehensive pain care.
Duration of Pain Management
- There is no specific mention of a one-month duration for pain management in the provided studies.
- 3 discusses the importance of understanding the characteristics of pain, including severity and nature, to provide appropriate treatment.
- 4 highlights the need for comprehensive pain management that includes evidence-based nonpharmacologic options, but does not specify a duration for pain management.
Physical Dependence
- 2 mentions that severe acute pain may necessitate short-term use of opioids with attention to minimizing risk, including in patients on medication-assisted therapy for opioid use disorder.
- 3 notes that opioids can cause cognitive deficiency, motor impairment, and respiratory depression, among other problems, and represent a significant addiction risk in certain groups of patients.
- There is no direct evidence in the provided studies to support a specific duration for pain management before physical dependence develops.