b'When the 2016 guideline was rst introduced,are 1) determining whether or not to initiate the country was on the heels of a widespreadopioidsforpain,2)opioidselectionand opioid epidemic. In 2016, opioid overdosesdosage, 3) opioid duration and follow-up, and caused more than 42,000 deaths in the United4) assessing risk and addressing harms of States. The guideline became incorrectlyopioid use. viewed as a law and several prescribersWhen determining whether or not to start became labeled as excessively prescribingopioids for pain, clinicians should consider opioids for venturing over the 90 MME perthe following: daymarkonprescriptions. The American1. Non-opioid therapies are effective for many MedicalAssociationoriginallywasinfullcommontypesofacutepain.Clinicians support of the guideline and later releasedshould only consider opioid therapy for acute statementsthatcallforrestraininginpain if benets are anticipated to outweigh implementing the CDC guidelineparticularlythe risks to the patient.asitappliestotheagencysmaximum recommended dose of 90 MME per day.2. Non-opioidtherapiesarepreferredfor To support, not supplant subacute and chronic pain. Clinicians should The 2022 draft guidance displays a moreonly consider initiating opioid therapy if relaxed stance, moving away from hard MMEexpected benets for pain and function are daily dose limits and recognizing that someanticipated to outweigh risks to the patient.patients may benet from greater than 90Not all patients may be candidates for MME per day of opioids. Language includingopioid treatment and it is important to dose limitations is avoided in the new guideline.consider the type of pain the patient is The updated guideline also makes an effortexperiencing. Decisions to start treatment to reduce the likelihood of misapplication bywith opioids should be based on the best any healthcare stakeholder, specically statingavailable evidence-based medicine and be the guideline should not be used by payerspatient-centered.and health systems to set rigid standardsOpioid selection and dosage selection related to dose or duration of opioid therapy.should be done with careful consideration The CDC notes an emphasis on the documentand the guideline recommends: being a voluntary clinical practice guideline1. Clinicians should prescribe immediate-[that] provides recommendations and doesrelease opioids, instead of extended-release, not require mandatory compliance. It iswhenstartingopioidtherapyforacute, intended to be exible so as to support, notsubacute, or chronic pain. supplant, clinical judgment and individualized2. When opioids are started for opioid-naive patient-centered decision making.patientswithacute,subacute,orchronic The new perspective pain, clinicians should prescribe the lowest The new guidelines include 12 recommen-dosage to achieve expected effects.dations focused on the four aspects of the3. For patients already receiving higher clinicalpracticeofpainmanagementforopioid dosages, clinicians should carefully outpatients with pain not related to sickle cell,weigh benets and risks and exercise care cancer, or palliative care. These four aspectswhen reducing or continuing opioid dosage. msfocusmagazine.org 45'