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Oregon Pain Guidance

Pain Treatment Guidelines

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — Nov. 2022
Acute Opioid Prescribing Guidelines
Chronic Opioid Prescribing Guidelines
  • Nociceptive and Neuropathic Pain
  • Central Pain or Central Sensitization (CS)
  • Additional Concerns
BRAVO, A Collaborative Approach to Tapering
Low Back Pain
  • Introduction
  • SPACE: The final frontier
  • Key points to remember
  • References and Resources
Non-Opioid Options
  • Treatment Comparisons
  • Non-Opioid Treatment Options
  • Behavioral Treatment Options
Pain Control in the Elderly and Individuals with Dementia
  • Chronic Pain in the Elderly Population
  • Evaluation of the Elderly Patient
  • Goals of Treatment
  • Non-Pharmaceutical Approach
  • Pharmaceutical Approach
  • Pain Treatment in Patients with Dementia
Pain Control for Cancer and Palliative Care
  • What Is Palliative Care
  • Why Is Palliative Care Important
  • Palliative Care Approaches
Recommended Opioid Policy for Dentists
  • Dental Section
Medications that Warrant Special Attention
  • Sleeping Pills (Z Drugs and Others)
  • Tramadol and Tapentadol
  • Carisoprodol
  • Meperidine
  • Long-Acting Opioids
  • Methadone
  • Gabapentin
The Art of Difficult Conversations
  • Value Identification
  • Realistic Expectations
  • Willingness to feel Uncomfortable
  • Relationship as a Resource
  • Belief and Confidence
  • Resources
Bravo opioid tapering

This booklet provides primary care providers with guidelines and tools to support them as they work with patients on long term opioid therapy. It is also intended to provide materials for academic detailing on tapering.

It incorporates guidance and content from these key sources:

  • U.S. Department of Health and Human Services Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics October 2019
  • Oregon Health Authority – Opioid Tapering Guidelines – Recommendations for individualized care to reduce harm from opioid use
  • BRAVO – A protocol developed by Dr. Anna Lembke (credits below)
  • Risk Benefit Analysis flowchart – Developed by the Oregon Pain Guidance Clinical Advisory Group and incorporated into the HHS guidelines on tapering
  • Veterans Health Administration Opioid Taper Decision Tool (withdrawal medications)

We are also grateful for the academic detailing framework provided by the National Resource Center for Academic Detailing (NaRCAD).

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