Chronic pain management: the impact of the new Centers for Disease Control guidelines

See the original patient information guidelines at : http://www.cdc.gov/drugoverdose/prescribing/patients.html

The guidelines do not apply to “acute” pain, hospice or end-of life care, or cancer care.  Think of acute pain as occurring during the body’s normal healing process.  The guidelines do apply to chronic pain.   By definition “chronic” pain is defined as lasting for at least three months.  Note that duration of pain does not describe the underlying physical mechanisms for the pain, just that the body’s normal healing process “should” have resolved the underlying physical problem.   The nervous system is still generating pain signals, despite the body having already “healed” the original injury.

However, most chronic conditions do seem to contain both acute and chronic components.  For example, I had a bike accident with left ulnar fracture (at the elbow).  The acute pain subsided within a month (throbbing, aching pain with tissue swelling).  The nerve related pain (numbness, electric jolts, extreme sensitivity to cold, deep achy feeling) persisted for four months at the same intensity before gradually subsiding over the next 15 months.   Acute and chronic sensations.

The new guidelines specifically caution health care providers to be very cautious with patients who use alcohol, benzodiazepines (such as Xanax or Valium), muscle relaxants (such as Soma or Flexeril), and hypnotic sleep aids (such as Ambien or Lunesta).   Further, the guidelines indicate more stringent limitation of both the amount and duration of opiate prescription for chronic pain.

The practical effect of the guidelines will likely be that patients with chronic pain will be prescribed fewer of these medications, for shorter duration, and with smaller doses.  Health care providers will be under increasing scrutiny and will have to have more extensive documentation for any decision to prescribe outside these guidelines.

If you or someone you know has any of these classes of medication prescribed for chronic pain, anticipate that the health care provider will be reviewing this information with them….. and may be changing (reducing?) those prescriptions.


Article Written By: Doug Peterson, PhD

Former Program Director, Center for Pain Rehabilitation at St. John’s Reg. Med. Ctr, Oxnard, CA. Doug Peterson is our clinical psychologist on the team. He received his doctorate in Psychology from State University of New York at Binghamton. Cognitive behavioral therapy Is his approach to psychotherapy. Dr. Peterson has special interest in issues associated with aging and the management of chronic medical conditions. 

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