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U.S. Department of Health and Human Services
Opioid Stewardship in the Indian Health Service

Acute and Subacute Pain

2022 CDC Pain Guidelines

The Centers for Disease Control and Prevention (CDC) published an updated Clinical Practice Guideline Exit Disclaimer: You Are Leaving www.ihs.gov  for prescribing opioids for pain, which includes guidance for acute and subacute pain. Acute pain is usually sudden in onset and time limited (duration of less than 1 month) and often is caused by injury, trauma, or medical treatments such as surgery. Subacute pain is acute pain that does not resolve within 1 month and is present for 1 to 3 months. Both acute and subacute pain can evolve into chronic pain.

The CDC also released a summarization that includes “At-A-Glance” Recommendations and guiding principles which are grouped into four areas of consideration to aid in treatment planning:

  • Determining whether or not to initiate opioids for pain
  • Selecting opioids and determining opioid dosages
  • Deciding duration of initial opioid prescription and conducting follow-up Assessing risk and addressing potential harms of opioid use

The guideline provides five guiding principles for its implementation.

  • All pain should be assessed and treated.
  • The recommendations provided within the guideline are voluntary and should be used to support individualized, person-centered care.
  • Multimodal pain management strategies are essential.
  • The clinical practice guideline should not be applied beyond its intended use, or it could lead to unintended and potentially harmful consequences for patients.
  • All clinicians, practices, health systems, and payers should work to vigilantly to attend to health inequities in order to ensure adequate pain management for all patients
    • .

Treatment should be individualized to each patient and multi-modal therapy should be the primary way to treat acute pain in all patients, with opioids reserved as a last line treatment. Goals of acute pain management are to reduce immediate suffering, improve function, and promote a positive patient experience, which includes balancing pain relief with achieving patient-specific functional goals while avoiding preventable complications. The same chronic pain concepts are applied to acute pain:

  • Patient engagement and shared decision making
  • Proper patient, pain, and functional statues assessments
  • Multimodal approach to pain relief, utilizing 2 or more strategies with different mechanisms that work to reduce one’s pain

Reference

CDC Clinical Practice Guideline for Prescribing Opioids for Pain Exit Disclaimer: You Are Leaving www.ihs.gov  – CDC MMWR Recommendations and Reports