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

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.

Background

People with acute pain who have developed a tolerance to opioids as a result of long-term use (via a prescription for chronic pain, opioid agonist therapy, or non-medical use) may have significantly higher opioid requirements and may need different doses to manage acute pain than those who have not taken opioids recently. Assessment and management should focus on effective analgesia, the use of strategies that may reduce the effects of opioid tolerance or opioid-induced hyperalgesia, and the prevention of withdrawal. Usual opioid doses should be maintained where possible, or appropriate substitutions should be made during acute-pain events.

Health care professionals should work closely with other treating health care professionals and specialist teams as required, including the person’s original opioid prescriber whenever possible. If relevant, they should perform appropriate discharge planning after hospitalization to ensure continuity of care in the long term.

Some people experience exacerbations of chronic diseases that cause acute pain (e.g., sickle cell disease). Health care professionals should follow disease-specific clinical guidelines to improve pain control and patient satisfaction for people with these conditions. People with chronic conditions may benefit from having a pain management plan, whether or not they take opioids regularly. In cases of exacerbations that cause acute pain, people with chronic diseases often require the rapid administration of oral or intravenous opioids (e.g., in the emergency department). Opioids should be prescribed carefully, as people with these conditions are still at risk of developing opioid use disorder.

What This Quality Statement Means

For Patients

If you are already taking opioids (perhaps because of chronic pain) and you are now experiencing acute pain, the health care professional providing care for your acute pain should communicate with the health care professional who has prescribed your current opioid prescription. They should work together to make changes to your regular opioid prescription or care plan, if needed, to make sure your pain is managed safely and effectively.

For Clinicians

Consider the risk of long-term opioid use and tolerance when prescribing opioids for acute pain. Wherever possible, communicate and coordinate care with the clinicians prescribing the person’s long-term opioids, and create a plan to taper to the original dose.

For Health Services

Ensure that systems and tools are available to help health care professionals coordinate care for people with acute pain who regularly take opioids. Facilities where surgery is performed should provide clinicians and patients with access to a pain specialist to help manage inadequately controlled postoperative pain or the care of people who are at high risk of inadequately controlled postoperative pain because of ongoing opioid use.

Quality Indicators

Process Indicators

Percentage of people with acute pain who regularly take opioids who receive care from a health care professional or team with expertise in pain management

Denominator: total number of people with acute pain who regularly take opioids
Numerator: number of people in the denominator who receive care from a health care professional or team with expertise in pain management
Data source: local data collection

Percentage of people with acute pain who regularly take opioids who have a documented plan to taper to their original dose following a dose increase to treat acute pain

Denominator: total number of people with acute pain who regularly take opioids who receive a dose increase to treat acute pain
Numerator: number of people in the denominator who have a documented plan to taper to their original dose
Data source: local data collection

Evidence to Improve Care