Since the beginning of the opioid crisis in the U.S., the Centers for Disease Control (CDC) periodically issues guidelines for the prescription and use of opioid medications. These guidelines were last updated in 2016, at a time when overdose deaths were increasing and just before it was declared a public health emergency. In response to the crisis, the NYS Workers’ Compensation Board (WCB) published Non-Acute Pain Guidelines, which essentially created a formula for doctors to follow when prescribing opioid medications and allows insurance companies and judges to make important decisions about a patient’s pain management.
Recently, the CDC updated their guidelines with 12 recommendations. The goal of these new guidelines is to provide patients with “compassionate, safe and effective” pain care. The CDC’s guidelines advocate for individualized, patient-centered care and focuses on prescribers using their professional expertise and judgment. The CDC has stated that pain management should not be an inflexible, one-size fits all treatment plan. It highlights that actions like rapid tapers, abrupt discontinuation of medication without collaboration with patients, rigid application of opioid dosage thresholds, duration limits imposed by insurers and pharmacies and patient dismissal and abandonment have contributed to patient harm. These harms include untreated and under treated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose and suicidal ideation and behavior.
The WCB’s current Non-Acute Pain Guidelines represent exactly the “one-size fits all” the CDC advocates against. Unfortunately, these updated guidelines are voluntary and are not likely to impact the current WCB guidelines. However, collaboration with your pain management provider can result in a more flexible interpretation of the WCB’s current guidelines and a more individualized treatment program.