Chronic pain often co-occurs with behavioral health conditions, including mental and substance use disorders ( 12, 13). Patients might experience persistent pain that is not well controlled ( 6). This complexity means substantial heterogeneity exists in the effectiveness of various pain treatments, depending on the type of underlying pain or condition being treated ( 7– 11). Pain is a complex phenomenon influenced by multiple factors, including biologic, psychological, and social factors ( 7). In 2011, the economic costs of chronic pain were estimated to range from $560 to $635 billion in annual direct medical costs, lost productivity, and disability ( 2). Pain, especially chronic pain, can affect almost every aspect of a person’s life, leading to impaired physical functioning, poor mental health, and reduced quality of life, and contributes to substantial morbidity each year ( 6). adults had chronic pain in 2019 and approximately one in 14 adults experienced “high-impact” chronic pain, defined as having pain on most days or every day during the past 3 months that limited life or work activities ( 5). Acute pain is usually sudden in onset and time limited (defined in this clinical practice guideline as having a duration of 3 months ( 4) and can be the result of an underlying medical disease or condition, injury, medical treatment, inflammation, or unknown cause ( 2). Acute pain, a nearly universal experience, is a physiologic response to noxious stimuli that can become pathologic. Pain is one of the most common reasons adults seek medical care in the United States ( 1). This clinical practice guideline is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy improve the effectiveness and safety of pain treatment mitigate pain improve function and quality of life for patients with pain and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. Recommendations should not be applied as inflexible standards of care across patient populations. CDC recommends that persons with pain receive appropriate pain treatment, with careful consideration of the benefits and risks of all treatment options in the context of the patient’s circumstances. CDC obtained input from the Board of Scientific Counselors of the National Center for Injury Prevention and Control (a federally chartered advisory committee), the public, and peer reviewers. Recommendations are based on systematic reviews of the scientific evidence and reflect considerations of benefits and harms, patient and clinician values and preferences, and resource allocation. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The guideline addresses the following four areas: 1) determining whether or not to initiate opioids for pain, 2) selecting opioids and determining opioid dosages, 3) deciding duration of initial opioid prescription and conducting follow-up, and 4) assessing risk and addressing potential harms of opioid use. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.

It updates the CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016 (MMWR Recomm Rep 2016 65:1–49) and includes recommendations for managing acute (duration of 3 months) pain. This guideline provides recommendations for clinicians providing pain care, including those prescribing opioids, for outpatients aged ≥18 years.

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