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Opioids for pain
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of opioids for pain are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2025), the American Academy of Pediatrics (AAP 2024), the American Society of Interventional Pain Physicians (ASIPP 2023), the Canadian Expert Group on Cannabinoids Use in Chronic Pain (CCP-CEG 2023), the ...
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Diagnostic investigations
Clinical assessment: as per ASIPP 2023 guidelines, obtain a comprehensive evaluation of pain history, medical history, psychosocial history, functional assessment, and appropriate consultations before initiating opioid therapy.
A
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Review of prescriptions
Screening for substance abuse
Genetic testing
Medical management
Indications for initiation: as per AAFP 2025 guidelines, avoid using opioid therapy as a first-line treatment for chronic nonterminal pain, and limit its use to circumstances where benefits outweigh risks.
D
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Choice of agent and dosage
Tapering and discontinuation
Non-opioid therapies
Antiemetic prophylaxis
Perioperative care
Specific circumstances
Pediatric patients: as per AAP 2024 guidelines, treat acute pain in pediatric patients using a multimodal approach including the appropriate use of nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications.
B
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Patients with postoperative pain
Patients with opioid use disorder
Patients with substance use disorder
Patients with renal/hepatic impairment
Patients with opioid-induced constipation
Patient education
Follow-up and surveillance
Clinical monitoring: as per ASIPP 2023 guidelines, assess meaningful benefit (at least 30% benefit in pain and/or function) produced by opioid therapy and ensure that opioid therapy does not incur aberrant behaviors and/or adverse effects.
B
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Urine drug monitoring