Opioid Prescribing for Acute Pain

Care for People 15 Years of Age and Older

Click below to see a list of brief quality statements and scroll down for more information.

Quality Statements in Brief

Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Comprehensive Assessment
People with acute pain receive a comprehensive assessment to guide pain management.

Quality Statement 2: Multimodal Therapies
People with acute pain receive multimodal therapy consisting of non-opioid pharmacotherapy with physical and/or psychological interventions, with opioids added only when appropriate.

Quality Quality Statement 3: Opioid Dose and Duration
People with acute pain who are prescribed opioids receive the lowest effective dose of the least potent immediate-release opioid. A duration of 3 days or less is often sufficient. A duration of more than 7 days is rarely indicated.

Quality Statement 4: Information on Benefits and Harms of Opioid Use and Shared Decision-Making
People with acute pain and their families and caregivers receive information about the potential benefits and harms of opioid therapy, safe storage, and safe disposal of unused medication at the times of both prescribing and dispensing.

Quality Statement 5: Acute Pain in People Who Regularly Take Opioids
People with acute pain who regularly take opioids receive care from a health care professional or team with expertise in pain management. Any short-term increase in opioids to treat acute pain is accompanied by a plan to taper to the previous dose.

Quality Statement 6: Acute Pain in People With Opioid Use Disorder
People taking buprenorphine/naloxone or methadone for the treatment of opioid use disorder continue their medication during acute-pain events.

Quality Statement 7: Prescription Monitoring Systems
Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed to avoid duplicate prescriptions, potentially harmful medication interactions, and diversion.

Quality Statement 8: Tapering and Discontinuation
People prescribed opioids for acute pain are aware of the potential for experiencing physical dependence and symptoms of withdrawal and have a plan for tapering and discontinuation.

Quality Statement 9: Health Care Professional Education
Health care professionals have the knowledge and skills to appropriately assess and treat acute pain using a multimodal approach; appropriately prescribe, monitor, taper, and discontinue opioids; and recognize and treat opioid use disorder.

Resources Quality Statements Advisory Committee About

1

Comprehensive Assessment

People with acute pain receive a comprehensive assessment to guide pain management.

Background

For people with acute pain, health care professionals should perform a comprehensive assessment that includes a history and physical examination to determine appropriate acute pain management depending on the diagnosis. Health care professionals should document the type and source of pain, the effects of the pain on function and quality of life, and other co-existing factors. If applicable, previous responses to postoperative treatment should be considered to guide pain management after surgery or other procedures. People with untreated or undertreated mental health conditions should be offered concurrent mental health care. With standardized processes and procedures, comprehensive assessments can be completed quickly in settings such as emergency departments or walk-in clinics.

People with acute pain should be assessed for any history of physical dependence or tolerance to opioids as well as any active or previous substance use disorders because these may be associated with increased opioid requirements, delayed recovery after surgery, and increased risks of harm. The presence of risk factors for opioid use disorder may influence the choice of medication, follow-up, monitoring, and tapering protocols after surgical procedures. Clinicians should also assess the use of other substances that may affect pain management, such as benzodiazepines, cocaine, alcohol, and other psychoactive substances.

In cases where co-existing chronic diseases cause recurrent episodes of acute pain, existing pain management plans and current or past use of opioids should be considered in the care plan for acute pain.

What This Quality Statement Means

For Patients

Before prescribing opioids, your health care professional should offer you a physical examination and ask about your physical and mental health, your medical history, any other medications you are taking, and how you responded to treatment for pain in the past.

For Clinicians

Perform a comprehensive assessment (see definition) for people with acute pain who are taking or for whom you are considering prescribing opioids.

For Health Services

Ensure systems, processes, and resources are in place to allow clinicians to perform comprehensive assessments of people with acute pain. This includes providing the time required to perform a comprehensive assessment, including history, and ensuring access to assessment tools and, where available, electronic medical histories and patient records.

Quality Indicators

Process Indicator

Percentage of people with acute pain prescribed an opioid who received a comprehensive assessment (see definition) prior to being prescribed opioid therapy

Denominator: total number of people with acute pain who were prescribed an opioid
Numerator: number of people in the denominator who received a comprehensive assessment (see definition) prior to being prescribed opioid therapy
Data source: local data collection

Definitions Used Within This Quality Statement

Comprehensive assessment

When opioids are prescribed, a comprehensive assessment includes all of the following:

The pain condition: anatomical site and frequency and severity of pain
Any other medical conditions
Psychosocial history, including history of trauma
Mental health status
Medication and substance use history
Functional status
Past and current substance use disorders
Past pain management and coping strategies

Evidence to Improve Care