Guideline for Prescribing Opioids for Pain

Centers for Disease Control and Prevention

Pain affects the lives of millions of Americans every day and improving pain care and the lives of patients with pain is a public health imperative. The Centers for Disease Control and Prevention (CDC) is releasing updated and expanded recommendations for clinicians providing pain care for adult outpatients with short- and long-term pain. These clinical recommendations, published in the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, will help clinicians work with their patients to ensure the safest and most effective pain care is provided. The publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.

“Patients with pain should receive compassionate, safe, and effective pain care. We want clinicians and patients to have the information they need to weigh the benefits of different approaches to pain care, with the goal of helping people reduce their pain and improve their quality of life,” said Christopher M. Jones, PharmD, DrPH, MPH, Acting Director of CDC’s National Center for Injury Prevention and Control.

The 2022 Clinical Practice Guideline addresses the following areas: 1) determining whether to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use.  The Clinical Practice Guideline supports the primary prevention pillar of the HHS Overdose Prevention Strategy – supporting the development and promotion of evidence-based treatments to effectively manage pain.

The guideline is a clinical tool to improve communication between clinicians and patients and empower them to make informed decisions about safe and effective pain care. The recommendations are voluntary and provide flexibility to clinicians and patients to support individualized, patient-centered care. They should not be used as an inflexible, one-size-fits-all policy or law or applied as a rigid standard of care or to replace clinical judgement about personalized treatment.

CDC followed a rigorous scientific process using the best available evidence and expert consultation to develop the 2022 Clinical Practice Guideline. An independent federal advisory committee, four peer reviewers, and members of the public reviewed the draft updated guideline, and CDC revised it in response to this feedback to foster a collaborative and transparent process. CDC also engaged with patients with pain, caregivers, and clinicians to gain insights and gather feedback from people directly impacted by the guideline. The expanded guideline aims to ensure equitable access to effective, informed, individualized, and safe pain care.

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How to Have the ‘You May Need Help’ Conversation

Today’s Caregiver | By Matt Vasile, MSW, ACSW

When we don’t live with our elderly loved ones, it can be difficult to know how they’re really doing living independently at home. But if you see physical, emotional or cognitive signs that they’re not able to take care of themselves the way they once were, it’s important to speak up. This could happen while you’re at their home or after you’ve visited them for the holidays.

If you think it will be a difficult conversation, know that you are not alone. When well-meaning children or other relatives bring up their concerns or suggest their older loved ones move somewhere they could have more assistance, they’re often met with pushback, disregard, and hostility. This is understandable, because any changes involved in one’s routine or home environment can feel like a compromise of independence and privacy, especially for seniors who may be experiencing physical and cognitive changes.

Having the “you may need help” conversation can be awkward and uncomfortable. But it’s possible, and you can do it if you approach the topic with patience, kindness, and respect. Based on my experience working in different home environments with older adults and family caregivers through Gary and Mary West PACE, here are some tips for having this important talk with your loved one.

• Use “I” statements and factually observe what has changed. (“I notice there are a lot of past due bills stacked on the table. You were always so good about paying things on time when we were growing up, have you been able to keep up with paying them?”)
• If commenting on their appearance or hygiene, ask open-ended questions. (“I’ve noticed you don’t like to style your hair as much lately, has anything changed?”)
• Try to restate what they are saying to you back to them to make sure you convey that you understand their wants, needs, and fears. (“It sounds like you’re concerned about people not respecting your privacy, is that accurate?”)
• If your loved one acknowledges they need help, don’t tell them what to do. Instead, ask what their priorities are and ask how they might prefer to solve a given problem. (“I can see that it’s hard for you to keep all your medications straight, but it’s really important to stay on top of that. What do you think you need the most help with?”)
• Give your loved one choices when talking about care. (“It sounds like you could either add a chair lift to help you get upstairs, or you could move your bedroom downstairs and have someone come in a few days a week to help you around the house. What sounds more feasible to you?”) 

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The Reluctance to Attend a Bereavement Support Group

Barbara Karnes, RN

We tend to be unprepared for dying and death and we are unprepared for grief. Most of us don’t understand mourning, its natural flow, all the feelings and emotions that grieving presents. We are numb, we are screaming inside, we are confused, we are lost, we are alone, isolated, angry, afraid---all a normal parts of grieving. The thing is, most of us don’t know that all of what I just mentioned is normal and natural. It is grief but in our pain we think there must be something wrong with us, we are the ones out of step, we are not normal.

This is where bereavement support groups come in. Support groups are for anyone experiencing a death. The groups are not for just those people having challenges in dealing with their loss but for any and everyone who has lost someone close to them, or not so close to them. Bereavement support groups offer guidance to understanding that there is a normal pattern of grief and gives support and a place to verbalize as the feelings unfold. It is a place where those who have walked in the same shoes can gather and find strength to continue the walk.

Hospices are mandated by Medicare to offer bereavement support groups. Churches often offer grief support groups as part of their community outreach. This support can be found in almost any community. The problem is that bereavement groups tend not to be attended. 

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RAISE Act Council Offers National Caregiver Support Strategy 

A 102-page report marks the RAISE Act Family Caregiving Advisory Council’s September completion of the first-of-its-kind National Strategy to Support Family Caregivers. The product of extensive deliberation and analysis of expert contributions, the report includes substantial background information on the current landscape of family caregiving, as well as many proposed federal, state and local actions in support of caregivers. The proposals are organized under five major goals: 

• Improved awareness of and outreach to family caregivers; 
• Inclusion of family caregivers in the care team; 
• Services and supports for family caregivers; 
• Financial and employment protections; and 
• Data, research, and best practices.  

The ACL website provides access to the entire document and supporting materials. Comments from the public are encouraged through the deadline of November 30. 

Publication of the national strategy has been met by enthusiastic reactions across the caregiving spectrum, including the Family Caregiver Alliance (FCA). “We share the authors’ hope,” FCA stated, “that as the Strategy is implemented—and as the nation more fully comes to understand and respond to the challenges faced by family caregivers—society will embrace the cultural and policy shifts necessary to support them. As a result, over time, lawmakers likely will be called upon to propose legislative changes to better support family caregivers. This is a historic moment for family caregiving because, as the Strategy introduction states, ‘This is the first time that ideas from local and state agencies and nonprofit organizations are integrated with recommendations for the federal government in a combined initiative dedicated to family caregiving. The development of these lists also represents the first time that agencies across the federal government have formally worked together to coordinate family caregiver support planning.’”