Update for Use of Opioids When Managing Chronic Pain

Update for Use of Opioids When Managing Chronic Pain

C-L psychiatrists encouraged to help reduce clinical uncertainty

In May 2022, the Department of Veterans Affairs and Department of Defense approved a joint clinical practice guideline for the use of opioids when managing chronic pain.

A synopsis in the latest Annotations summarizes the recommendations that the authors believe are the most important to highlight based on their clinical relevance.

Recommendations for the initiation and continuation of opioid therapy; dose, duration, and taper of opioids; screening, assessment, and evaluation; and risk mitigation are covered.

New additions highlighted include recommendations about the use of buprenorphine instead of full agonist opioids; assessing for behavioral health conditions and factors associated with higher risk for harm, such as pain catastrophizing; and the use of pain and opioid education to reduce the risk for prolonged opioid use for postsurgical pain.

The guideline itself, say the authors, reflects the challenge clinicians and patients experience when managing chronic pain and recognizes the need to assess for and treat behavioral health conditions that may co-occur.

However, they say, the guideline does not clearly specify how buprenorphine should be implemented, as the quality of evidence for the use of buprenorphine is low. “More research about the formulation, dosing, and clinical characteristics are needed to support the use of buprenorphine for treatment of chronic pain.”

When adopting these guidelines, C-L psychiatrists may encounter an increase in consultations for behavioral health concerns during the peri-operative window.

Yet, “providing liaison education and treatment for possible co-occurring psychiatric conditions and supporting the use of buprenorphine over full agonist opioids will reduce risk and exposure to prescription opioids while providing optimum care for patients with chronic pain.”

C-L psychiatrists are encouraged to publish their findings to reduce clinical uncertainty surrounding this topic.

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