2022 Opioid Prescribing Guideline Acknowledges Value and Barriers to Non-drug Treatments for Pain

The Centers for Disease Control and Prevention (CDC) last week released its 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain. CDC offers clinicians 12 recommendations for treating acute, subacute and chronic pain, providing specific guidance for the use of prescription opioids as well as information on the value of nonopioid and noninvasive, nonpharmacologic approaches in treatment plans.

The guideline updates and expands CDC’s 2016 opioid prescribing guideline using the best available evidence as well as extensive feedback collected from clinicians, patients and caregivers during a public comment period earlier this year (read ACA’s comments to CDC).

Responding to concerns that the previous guideline was implemented too rigidly by some, the 2022 guideline puts added emphasis on clinical decision making and the importance of patient-centered care that is tailored to each person’s circumstances. It promotes the use where appropriate of nonopioid and nonpharmacologic approaches and addresses health insurance inequities that prevent some patients from accessing nonpharmacologic options for their pain.

Highlighting the role that nonopioid and nonpharmacologic treatments can play in helping patients avoid unnecessary opioid use, Recommendations 1 and 2 under the section “Determining Whether or Not to Initiate Opioids for Pain,” state in part, “Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient” and only consider opioid therapy if benefits are anticipated to outweigh risks.

Likewise, under “Noninvasive Nonpharmacologic Approaches to Acute Pain,” the guideline states that nonpharmacologic approaches “have the potential to improve pain and function without risk for serious harms.” In example, it cites spinal manipulation as one treatment that might be helpful for patients with acute low back pain with radiculopathy.

While the CDC guideline highlights the benefits and effectiveness of nonpharmacologic treatments as part of a multimodal, multidisciplinary approach to pain management, the agency acknowledges that not all health insurance covers these services, creating significant barriers for some patients.

“Health insurers and health systems can contribute to improved pain management and reduced medication use by increasing access to noninvasive nonpharmacologic therapies with evidence of effectiveness,” the guideline states.

Elsewhere in the guideline, CDC notes specifically that, “Public and private payers can support a broader array of nonpharmacologic interventions such as exercise, multidisciplinary rehabilitation, mind-body interventions, cognitive behavioral therapy, and certain complementary and integrative medicine therapies (e.g., acupuncture and spinal manipulation) that increasingly are known to be effective.”

To read the CDC recommendations in full, click here. In addition, CDC will hold a webinar about the new opioid prescribing guideline on Nov. 17 from 2-3 p.m. ET. For more information and to register, click here.