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12 TFAH • WBT • PaininTheNation.org Pain Treatment & Management Practices Patients should not suffer in pain. At the same time, healthcare providers have a responsibility to ensure they are relieving their patients' pain in ways that do not leave their patients vulnerable to substance addiction and misuse. Healthcare systems must develop pain treatment and management practices that require their physicians to treat pain responsibly, including clear guidelines on opioid prescribing, educating patients and prescribers on opioid risks; training healthcare providers to identify early signs of an opioid use disorder; and expanding prescription drug monitoring programs (PDMP) and other tools to detect misuse and diversion. The U.S. Centers for Disease Control and Prevention's (CDC) Guideline for Prescribing Opioids for Chronic Pain can serve as a resource in this process. The Guideline recommends that, when not treating active cancer, palliative or end-of-life care, healthcare providers: 1. Not use opioids as a first-line treatment; 2. Establish goals for pain reduction and function and continue opioid use only if the benefits of opioids towards meeting these goals outweigh the risk; 3. Inform patients of the benefits and risks of opioid use; 4. Begin opioid treatment with immediate-release versions; 5. Use the lowest effective dose when prescribing opioids; 6. Prescribe opioids in short duration for acute pain; 7. Frequently reevaluate the harms and benefits of continued use of opioids; 8. Use risk reduction strategies, such as naloxone; 9. Review PDMP data; 10. Drug test patients prior to starting opioid therapy and at least annually; 11. Avoid prescribing opioid and benzodiazepine concurrently; and 12. Offer treatment, including MAT, for patients with opioid use disorder. 79 Alternative therapies to opioids include physical therapy, cognitive behavioral therapy, localized nerve blocking and non-opioid medications, such as acetaminophen or ibuprofen. Many of these treatments can be as or more effective than opioids. In fact, the Journal of the American Medical Association published new research in March 2018 that found that ibuprofen, acetaminophen and other nonsteroidal anti-inflammatory drugs reduced pain more than opioids in patients with chronic back, knee and hip pain. 80 PDMPs, recommended in CDC's Guideline, are an important tool for healthcare systems working to establish responsible opioid prescribing practices. These electronic databases allow healthcare professionals to access information about the dispensing of controlled substances statewide and the data can help physicians avoid dangerous drug interactions and identify "doctor shopping" patients seeking multiple opioid prescriptions. PDMPs also allow healthcare systems to identify possible provider overprescribing, both intentional and unintentional. The Partnership for Drug-Free Kids' prescriber education initiative, Search The Journal of the American Medical Association published new research in March 2017 that found that ibuprofen, acetaminophen and other nonsteroidal anti-inflammatory drugs reduced pain more than opioids in patients with chronic back, knee and hip pain. 80

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