Pain Management UpdatesUpdated Pain Management CME Course and Resources
The Oregon Pain Management Commission (OPMC) recently launched a new version of “Changing the Conversation About Pain," a CME course that will be required for all Oregon clinicians beginning January 1, 2022. The updated course now includes topics such as health equity and has been expanded from 1.0 to 1.5 CME credit hours.
Additionally, a workgroup comprised of representatives of the OPMC, Oregon Health Authority (OHA) Public Health, and Providence Health & Safety, as well as six clinical experts, have developed the Pain Education Toolkit, which offers patient and provider educational resources on topics such as sleep, nutrition, and medications. Visit OregonPainGuidance.org/paineducationtoolkit to access the toolkit. A clinician-focused version is also available at OregonPainGuidance.org/paineducationtoolkitforclinicians.
ATTENTION: The Oregon Health Authority adopted temporary rules to align with requirements in 42 U.S.C. 1396w-3a. The temporary rules require Oregon Health Plan (OHP) enrolled providers and Coordinated Care Organization (CCO) contracted providers to check the Prescription Drug Monitoring Program (PDMP) before prescribing controlled substances to covered individuals, see
OAR 410-120-1260(13) and
OAR 410-141-3855(15) for details.
ATTENTION: CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain
Authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain are advising against misapplication of the guideline that can risk patient health and safety, raising awareness of the following issues:
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Misapplication of recommendations to populations outside of the Guideline's scope. The Guideline is intended for primary care clinicians treating chronic pain for patients 18 and older. Examples of misapplication include applying the Guideline to patients in active cancer treatment, patients experiencing acute sickle cell crises, or patients experiencing post-surgical pain.
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Misapplication of the Guideline's dosage recommendation that results in hard limits or “cutting off" opioids. The Guideline states, “When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should… avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day." The recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages.
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The Guideline does not support abrupt tapering or sudden discontinuation of opioids. These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids. In addition, policies that mandate hard limits conflict with the Guideline's emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.
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Misapplication of the Guideline's dosage recommendation to patients receiving or starting medication-assisted treatment for opioid use disorder. The Guideline's recommendation about dosage applies to use of opioids in the management of chronic pain, not to the use of medication-assisted treatment for opioid use disorder. The Guideline strongly recommends offering medication-assisted treatment for patients with opioid use disorder.
More information about the CDC Guideline for Prescribing Opioids for Chronic Pain and how appropriately apply it to patient care, visit the
CDC's website.
ATTENTION: In July 2020, the Food and Drug Administration provided guidance directing health care professionals to discuss naloxone, a potentially life-saving medication that can reverse drug overdoses, with all patients when prescribing opioid pain relievers or medicines to treat opioid use disorder. See the
FDA's website for additional information.