From the Guidelines
Nurse practitioners can prescribe chronic pain medications, including opioids, in most states, but their authority is subject to varying regulations and restrictions. The Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids for chronic pain, published in 2016 1, emphasizes the importance of nonopioid therapy as the preferred treatment for chronic pain and recommends that opioids be used only when benefits for pain and function are expected to outweigh risks. According to this guideline, clinicians, including nurse practitioners, should establish treatment goals with patients, consider how opioids will be discontinued if benefits do not outweigh risks, and communicate with mental health professionals managing the patient to discuss the patient’s needs and prioritize patient goals.
When prescribing opioids, nurse practitioners must follow the same standards of care as physicians, including thorough patient assessment, documentation, monitoring for efficacy and side effects, and implementing risk mitigation strategies. The CDC guideline recommends that clinicians offer or arrange evidence-based treatment, usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies, for patients with opioid use disorder 1. Nurse practitioners should also be aware of the regulations and restrictions in their state regarding the prescribing of controlled substances, including mandatory continuing education in pain management, checking prescription drug monitoring programs before prescribing, and limitations on dosage or duration.
Key considerations for nurse practitioners prescribing chronic pain medications include:
- Nonopioid therapy is preferred for treatment of chronic pain
- Opioids should be used only when benefits for pain and function are expected to outweigh risks
- Thorough patient assessment, documentation, and monitoring for efficacy and side effects are essential
- Risk mitigation strategies, such as checking prescription drug monitoring programs, should be implemented
- Evidence-based treatment, including medication-assisted treatment, should be offered or arranged for patients with opioid use disorder 1.
From the Research
Nurse Practitioners' Authority to Prescribe Chronic Pain Medications
- Nurse practitioners (NPs) are well-suited to manage chronic pain due to their holistic approach to care and growing numbers in primary care 2.
- However, challenges exist in caring for chronic pain patients, such as preventing opioid-related adverse events, a lack of available non-pharmacologic alternatives, and limitations in prescriptive authority 2.
- The role of NPs in opioid prescription has expanded, but their prescription of opioids for chronic pain management is not well understood 3.
Barriers and Facilitators to Nurse Practitioners' Opioid Management
- Barriers to NPs' opioid management include nurse practitioner education, patient subjectivity and patient education, systemic change and alternative treatment access, interprofessional collaboration, nurse practitioner prescriptive authority, and practice environment 3.
- Facilitators to NPs' opioid management include providing current guideline-based education regarding opioid prescription, emphasizing patient education, supplying NPs with systemic support, encouraging interprofessional collaboration, and solving prescriptive authority issues 3.
Treatment Options for Chronic Pain
- Available drug treatments for chronic pain include simple analgesics such as acetaminophen, salicylates and other nonsteroidal anti-inflammatory drugs, traditional opioid drugs, and adjuvant agents 4, 5.
- Combination therapy, such as combining opioids and non-opioids, may increase the analgesic potency of opioids, reduce the development of tolerance and dependence, and reduce other clinically significant side effects associated with prolonged opioid use 6.