CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.
CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.
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DOI：
10.15585/mmwr.rr7103a1
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发表时间：
2022-11-04
影响因子：
33.7
通讯作者：
Chou, Roger
中科院分区：
文献类型：
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作者：
Dowell, Deborah;Ragan, Kathleen R;Jones, Christopher M;Baldwin, Grant T;Chou, Roger
本指南为临床医生提供疼痛治疗建议，包括为18岁及以上门诊患者开具阿片类药物的医生。它更新了美国疾控中心2016年《慢性疼痛阿片类药物处方指南》（《发病率和死亡率周报》建议报告2016年；65[第RR - 1号]：1 - 49页），并包含了对急性（持续时间<1个月）、亚急性（持续时间1 - 3个月）和慢性（持续时间>3个月）疼痛管理的建议。这些建议不适用于镰状细胞病或癌症相关疼痛，也不适用于接受姑息治疗或临终关怀的患者。该指南涉及以下四个方面：1）确定是否针对疼痛开始使用阿片类药物，2）选择阿片类药物并确定其剂量，3）决定初始阿片类药物处方的时长并进行随访，4）评估风险以及处理阿片类药物使用的潜在危害。疾控中心使用推荐意见评估、制定与评价（GRADE）框架制定了本指南。建议基于对科学证据的系统综述，并反映了对利弊、患者及临床医生的价值观和偏好以及资源分配的考虑。疾控中心征求了国家伤害预防与控制中心科学顾问委员会（一个联邦特许的咨询委员会）、公众以及同行评审人员的意见。疾控中心建议疼痛患者接受适当的疼痛治疗，同时根据患者的具体情况仔细考虑所有治疗方案的利弊。建议不应作为僵化的护理标准应用于所有患者群体。本临床实践指南旨在改善临床医生与患者之间关于疼痛治疗（包括阿片类药物治疗）利弊的沟通；提高疼痛治疗的有效性和安全性；缓解疼痛；改善疼痛患者的功能和生活质量；并降低与阿片类药物疼痛治疗相关的风险，包括阿片类药物使用障碍、过量和死亡。
This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years. It updates the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (MMWR Recomm Rep 2016;65[No. RR-1]:1–49) and includes recommendations for managing acute (duration of <1 month), subacute (duration of 1–3 months), and chronic (duration of >3 months) pain. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. Recommendations should not be applied as inflexible standards of care across patient populations. This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death.