In another indication that the CDC sees these new guidelines as a course correction from previous ones, the agency is now suggesting that when patients test positive for illicit substances, doctors should offer counseling, treatment and, if necessary, a careful reduction. Because doctors had interpreted the 2016 dosage limits narrowly, some had developed one-shot policies and were summarily expelling such patients.
Dr Jones said these results should rather be considered as diagnostic information among many others. An excessively high level of opioids could indicate that the patient is still suffering from untreated pain or even a substance use disorder. “If you instead retain the patient and have these conversations, now there is an opportunity to improve the patient’s life,” he said.
Drawing on a mountain of research accumulated over the past few years, the proposed guidelines also offer detailed recommendations for the treatment of acute pain – short-term pain that can accompany an injury such as a broken bone or the aftereffects of a surgical intervention. They advise against prescribing opioids except for traumatic injuries, such as burns and car accidents.
In detail, they compare the relief provided by opioids to that provided by alternatives such as exercise, acupuncture and other medications. And they give specific recommendations for discrete areas of pain, such as the lower back, knees, and neck.
The guidelines, for example, note that opioids should not be used for episodic migraines. They endorse, among other treatments, heat therapy and weight loss for knee osteoarthritis, and for neck pain, suggest options like yoga, tai chi, qigong, massage, and acupuncture.
Dr Marie Hanna, associate professor of anesthesia and critical care at Johns Hopkins University School of Medicine, said she was particularly enthusiastic about the depth and breadth of research that the guidelines provide supportive non-opioid treatments, including manual manipulation, laser therapy, and exercise.
“This is what we had been talking about for years, but no one was listening. Now we have the evidence to show that these treatments are effective. I’m very optimistic,” added Dr. Hanna, a member of the American Academy of Pain Medicine, an organization of pain researchers and providers in multiple disciplines.