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Oregon Pain Guidance

Guidelines Home

CDC Clinical Practice Guideline for Prescribing Opioids for Pain — Nov. 2022
Low Back Pain
  • Introduction
  • SPACE: The final frontier
  • Key points to remember
  • References and Resources
  • For Providers
  • For Patients
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
Non-Opioid Options
  • Treatment Comparisons
  • Non-Opioid Treatment Options
  • Behavioral Treatment Options
Specialty Care Treating Chronic Pain
  • Patient Selection for Pain Specialty Care
  • Screening and Evaluation
  • Oversight
  • Pain Specialty
  • Services
  • Long-Term Management Goals
Trauma-Informed Care (Childhood Trauma, PTSD & Chronic Pain)
  • Trauma and Chronic Pain
  • Screening and Referral Overview
  • Trauma-Informed Treatment
  • What Can Healthcare Providers Do
  • Tools
Treating Pain in Children and Adolescents
  • Assessment
  • Non­-Opioid Treatment
  • Opioid Treatment
  • Tools for Adolescents
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
Opioid Use During Pregnancy
Managing Patients in the Emergency Department
Recommended Opioid Policy for Dentists
  • Dental Section
Other Considerations
  • Prescription Drug Monitoring Program (PDMP)
  • Concomitant Benzodiazepine and Opioid Use
  • Concomitant Marijuana and Opioid Use
  • Disposal
  • Medication-Assisted Treatment (MAT)
  • Heroin
  • Naloxone
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
Collaborative approach to 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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