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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

Preoperative counseling: as per DoD/VA 2022 guidelines, consider providing patients with preoperative opioid and pain management education to decrease the risk of prolonged opioid use for postoperative pain.
C

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

General counseling: as per AAFP 2025 guidelines, consider discussing and clearly documenting realistic goals for function, pain, and QoL throughout the course of long-term opioid therapy.
C

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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