Scope of this summary
Outpatients aged 18 years or older with pain lasting more than three months, excluding pain related to sickle cell disease, active cancer treatment, palliative care or end-of-life care from the CDC opioid-guideline scope.
The Bottom Line
- Validate the patient’s pain and define mechanisms, contributors, function and goals without requiring a single structural lesion to justify care or assuming that pain intensity alone determines treatment.
- Build a multimodal plan around condition-specific nonpharmacologic and nonopioid pharmacologic treatments, sleep, mood, movement and social barriers, measuring function as well as symptom change.
- Prefer nonopioid therapies for chronic pain and consider starting an opioid only when expected benefits for pain and function are likely to outweigh risks after an informed, individualized discussion.
- For established opioid therapy, review benefit and harm collaboratively and avoid rigid thresholds, abrupt discontinuation, rapid forced taper or dismissal from care.
Practical clinical workflow
1
Characterize location, quality, neurologic features, trajectory, prior injury or disease, sleep, mood, trauma, substances, current medicines, work, caregiving and meaningful activities the patient wants to regain.
2
Examine for a coherent pain mechanism and urgent disease, review prior records and tests and avoid repeating imaging when it will not change management or explain function.
3
Agree on staged treatments and measurable functional goals, choosing physical, behavioral, interventional and medication options according to diagnosis, evidence, access and patient preference.
4
If opioids are used, review state prescription data where applicable, toxicology when clinically useful, concurrent sedatives, naloxone need, treatment response and signs of opioid-use disorder at planned follow-up.
Safety boundaries and escalation
- New motor or sphincter deficit, fever, cancer red flags, fracture risk, acute vascular symptoms, rapidly progressive neurologic change or suicidal crisis requires urgent diagnostic assessment rather than routine pain escalation.
- Opioids combined with benzodiazepines, alcohol or other sedatives increase overdose risk; offer naloxone when risk factors are present and provide overdose education.
- When opioid-use disorder is identified, offer or arrange evidence-based medication treatment; do not abandon pain care or use punitive discharge as a safety strategy.
- A taper can cause withdrawal, distress and destabilization when too rapid; unless there is a life-threatening issue, plan changes collaboratively, monitor closely and maintain access to care.
Localization
CDC 2022 is voluntary guidance, not a law or inflexible dose policy, and explicitly excludes cancer, sickle cell, palliative and end-of-life pain. State controlled-substance law, prescription-monitoring requirements, Medicaid and insurer rules vary.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Centers for Disease Control and PreventionCDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022MMWR 71(3); DOI 10.15585/mmwr.rr7103a1 · published 2022-11-04 · accessed 2026-08-20view source
- U.S. Department of Veterans Affairs and U.S. Department of Defense Evidence-Based Practice Work GroupVA/DoD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic PainVersion 4.0 (2022) · published 2022-05-01 · accessed 2026-08-20view source
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