Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Opioids for pain

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 Society of Interventional Pain Physicians (ASIPP 2023), the Canadian Expert Group on Cannabinoids Use in Chronic Pain (CCP-CEG 2023), the United States Department of Defense (DoD/VA 2022), the Center for Disease Control (CDC 2022), the American Society of Clinical Oncology (ASCO 2022), the Global Alliance for Infection in Surgery (GAIS/WSES/AAST/SIAARTI 2022), the American Society of Pain and Neuroscience (ASPN 2021), the French Society of Anesthesia and Intensive Care (SFAR 2019), the American Gastroenterological Association (AGA 2019), the European Society of Medical Oncology (ESMO 2018), the Canadian Medical Association (CMA 2017), the Multinational Association of Supportive Care in Cancer (MASCC/ESMO 2016), and the American Society of Anesthesiologists (ASA/APS/ASRA 2016).
1
2
3
4
5
6
7
8
9
10
11
12
13

Guidelines

1.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
Create free account

More topics in this section

  • Review of prescriptions

  • Screening for substance abuse

  • Genetic testing

2.Medical management

Indications for initiation
As per ASCO 2022 guidelines:
Initiate opioids in patients with moderate-to-severe pain related to cancer or active cancer treatment, unless contraindicated.
B
Discuss goals regarding functional outcomes, shared expectations, and pain intensity, as well as any concerns about opioids before initiating opioid therapy.
A

More topics in this section

  • Choice of agent and dosage

  • Tapering and discontinuation

  • Non-opioid therapies

  • Non-opioid therapies (CEG-CCP)

  • Antiemetic prophylaxis

3.Perioperative care

Preoperative counseling: consider providing patients with preoperative opioid and pain management education to decrease the risk of prolonged opioid use for postoperative pain.
C

4.Specific circumstances

Patients with postoperative pain: as per WSES 2022 guidelines, administer a major opioid for the treatment of moderate-to-severe pain unresponsive to other medications, if regional anesthesia techniques are not indicated.
B
Show 4 more

More topics in this section

  • Patients with opioid use disorder

  • Patients with substance use disorder

  • Patients with renal/hepatic impairment

  • Patients with opioid-induced constipation

5.Patient education

Pretreatment counseling: discuss the realistic benefits and known risks of opioids with patients before initiating opioid therapy. Establish clear treatment goals for pain and/or function discussing how opioid therapy will be discontinued if benefits do not outweigh risks.
A
Show 2 more

6.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
Show 4 more

More topics in this section

  • Urine drug monitoring