Chronic Pain Assessment
Pain lasting >3 months or beyond expected healing
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Family MedicineManagement
Chronic Pain Management (CDC 2022 Guidelines)
Chronic Pain Management (CDC 2022 Guidelines): Chronic Pain Assessment → Comprehensive Pain Evaluation → Pain Type Classification → Non-Pharmacologic Fi...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Action Comprehensive Pain Evaluation
Multimodal assessment
- Pain history: location, intensity (0-10), quality, timing
- Functional impact: work, ADLs, sleep, mood
- Prior treatments and response
- Screen for depression, anxiety (common comorbidities)
- Assess opioid risk (ORT, SOAPP-R)
03Decision Pain Type Classification
Guide treatment selection
- Nociceptive: Mechanical/inflammatory (OA, low back)
- Neuropathic: Burning, shooting (diabetic, post-herpetic)
- Nociplastic: Central sensitization (fibromyalgia)
- Mixed: Often has components of multiple types
04Action Non-Pharmacologic First
Foundation of chronic pain treatment
- Physical therapy / exercise
- Cognitive behavioral therapy for pain
- Mindfulness-based stress reduction
- Acupuncture (moderate evidence)
- Massage, heat, cold therapy
- Weight loss if applicable
05Action Ongoing Monitoring
Required for all chronic pain management
- Reassess pain and function regularly
- Check PDMP before each opioid prescription
- Urine drug screen periodically
- Assess for opioid use disorder (DSM-5)
- Document risk-benefit at each visit
06Decision Functional Improvement?
Goals met with acceptable side effects
07Outcome Continue Current Therapy
Maintain at lowest effective dose
08Action Modify Approach
If not improving or adverse effects
- Add non-pharmacologic modalities
- Rotate medications
- Consider specialty referral (pain clinic)
- If on opioids: slow taper if not beneficial
- Address psychosocial factors
- Path rejoins step 05Shared downstream outcome
09Warning OUD Concern
Signs of opioid use disorder
- Craving, loss of control, continued use despite harm
- Offer evidence-based treatment: buprenorphine, naltrexone
- Refer to addiction medicine if complex
- Do not abruptly discontinue opioids
- Harm reduction approach
10Action Non-Opioid Pharmacotherapy
First-line medications
- NSAIDs/acetaminophen for nociceptive pain
- Duloxetine/venlafaxine for neuropathic/nociplastic
- Gabapentin/pregabalin for neuropathic
- TCAs (amitriptyline) low-dose for neuropathic
- Topical lidocaine, capsaicin
11Decision Consider Opioids?
Only if benefits outweigh risks
- Non-opioid options inadequate or contraindicated
- Functional goals clear
- No active substance use disorder
- Benefits expected to outweigh risks
12Warning Opioid Initiation (If Indicated)
CDC 2022 guidance
- Start lowest effective dose (≤50 MME/day)
- Immediate-release before extended-release
- Avoid ≥90 MME/day without careful reassessment
- Co-prescribe naloxone if ≥50 MME or risk factors
- Written treatment agreement recommended
- Path rejoins step 05Shared downstream outcome
- Path rejoins step 05Shared downstream outcome
Guideline Source
CDC Clinical Practice Guideline for Prescribing Opioids for Pain 2022
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address cancer pain or palliative care
- Opioid tapering protocols simplified
- Interventional procedures not detailed
- Complex regional pain syndrome not specifically addressed
- Substance use disorder treatment abbreviated
Applicable Regions
USAUUKEU
AU: TGA opioid regulatory framework applies
UK: NICE chronic pain pathway differs
US: CDC 2022 opioid prescribing guidelines
Version 1Next review: 2027-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Chronic Pain Management (CDC 2022 Guidelines)?
The Chronic Pain Management (CDC 2022 Guidelines) is a management clinical algorithm for Family Medicine. It provides a structured decision tree to guide clinical decision-making, based on CDC Clinical Practice Guideline for Prescribing Opioids for Pain 2022.
What guideline is the Chronic Pain Management (CDC 2022 Guidelines) based on?
This algorithm is based on CDC Clinical Practice Guideline for Prescribing Opioids for Pain 2022 (DOI: 10.15585/mmwr.rr7103a1).
What are the limitations of the Chronic Pain Management (CDC 2022 Guidelines)?
Known limitations include: Does not address cancer pain or palliative care; Opioid tapering protocols simplified; Interventional procedures not detailed; Complex regional pain syndrome not specifically addressed; Substance use disorder treatment abbreviated. Individual patient factors may require deviation from these recommendations.
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