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

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.

Background

Most acute pain in primary care, dental, and postoperative settings can be successfully treated with a multimodal therapeutic approach consisting of a combination of non-opioid pharmacotherapy and nonpharmacological interventions. The use of a non-opioid-based multimodal approach compared with a primarily opioid-based approach improves pain control and reduces overall opioid consumption and adverse effects. Not all people undergoing surgery require opioids postoperatively; therefore, a multimodal pain management plan should be developed before the procedure. Regarding people experiencing significant postoperative pain requiring opioid therapy, parenteral opioids should be avoided in those who are able to take medication orally because their use may be associated with a greater risk of long-term opioid use and opioid-related harms.

Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) reduce opioid consumption when used as part of a multimodal approach to therapy and are effective as first-line analgesia for many types of acute pain in people without contraindications. Other pharmacological or nonpharmacological therapies and techniques may be considered based on the pain assessment and diagnosis. To help people prepare for surgery, painful medical procedures, or postsurgical pain, health care professionals may consider the use of pre-emptive analgesia or psychological interventions, such as cognitive behavioural therapy, guided imagery, and other relaxation techniques, as part of a multimodal approach; however, it is unclear which techniques are most effective.

What This Quality Statement Means

For Patients

Your health care professional should offer you a variety of ways to manage your pain, including different kinds of physical therapies and medications, depending on the cause of your pain. You should be offered opioids only when other types of treatment are unable to manage your pain.

For Clinicians

Offer people with acute pain multimodal therapy based on the clinical diagnosis. Offer opioids only when necessary to provide adequate pain relief, and include them as part of a multimodal approach. If the person can tolerate oral medications, oral opioids are preferred over parenteral opioids.

For Health Services

Ensure that systems, resources, and training are available to allow health care professionals to deliver multimodal therapy for acute pain. Ensure that people with acute pain have equitable access to these therapies and the ability to access timely follow-up for acute pain that does not resolve.

Quality Indicators

Process Indicators

Percentage of people with acute pain whose pain was managed using a multimodal approach

Denominator: total number of people with acute pain
Numerator: number of people in the denominator who received non-opioid and/or nonpharmacological therapies to manage their acute pain
Data source: local data collection

Percentage of people with acute pain prescribed an opioid who received physical or psychological interventions or non-opioid pharmacotherapy (acetaminophen and/or nonsteroidal anti-inflammatory drugs) as first-line treatment prior to being prescribed an opioid

Denominator: total number of people with acute pain who were prescribed an opioid and did not have an opioid prescription in the previous 6 months
Numerator: number of people in the denominator who received physical or psychological interventions or non-opioid pharmacotherapy as first-line treatment prior to being prescribed an opioid
Data source: local data collection

Percentage of people with acute pain newly started on opioid therapy

Denominator: total number of people with acute pain who did not have an opioid prescription in the previous 6 months
Numerator: number of people in the denominator who were prescribed an opioid
Data sources: local data collection or linked administrative databases, including the Narcotics Monitoring System

Definitions Used Within This Quality Statement

Multimodal therapy

Multimodal therapy is the use of a combination of different analgesic medications, interventional techniques, and/or nonpharmacological interventions that target different mechanisms of action in the peripheral or central nervous system.

Non-opioid pharmacotherapy

Examples of non-opioid pharmacological therapies include the following:

Acetaminophen
Nonsteroidal anti-inflammatory drugs
Anticonvulsants, such as gabapentin and pregabalin
Antidepressants, such as amitriptyline, nortriptyline, and duloxetine

Nonpharmacological therapies

There are a broad range of nonpharmacological therapies that may be used to manage acute pain. The efficacy of each therapy may vary by type or cause of pain.

Examples of self-management interventions include the following:

Heat
Ice
Massage
Stretching
Rest

Examples of nonpharmacological interventions provided by a health care professional include the following:

Acupuncture
Bracing or wrapping
Spinal manipulation
Passive physical therapy
Positioning
Splints
Transcutaneous electrical nerve stimulation (TENS)

Psychological therapies include the following:

Self-management programs (in-person or online)
Interventions provided by health care professionals, including cognitive behavioural therapy, guided imagery, hypnosis, and relaxation techniques. Some of these modalities should be engaged prior to surgery or a painful medical procedure

Interventional treatments, such as therapeutic injections, are percutaneous or minor surgical procedures targeting specific anatomical structures identified as sources of pain.

Evidence to Improve Care