AAPM recommends these basic guidelines: 

  • Opioids should only be started after a complete evaluation and pain history.

  • A treatment plan for opioids should be agreed upon and put in place.

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  • The treatment plan should be periodically reviewed.

  • Careful documentation should be kept to prevent diversion.

  • A pain treatment program should include psychological and behavioral strategies as well as medication.

  • Responsible use of opioids should not be inhibited by fear of state or federal regulatory actions.

“We have to uncouple the tendency to think first of opioids in the face of chronic pain. Opioids have their place, but behavioral interventions and non-opioid analgesics should come first,” said Hooten. 

There are no easy answers when it comes to using opioids for chronic pain. There are some pluses, but there are lots of minuses to consider. Unfortunately, for many people there is no cure for chronic pain. Until something better comes along, physicians need to use their best judgment and try to provide the best possible quality of life.1 “For primary care providers dealing with chronic pain, a consultation with a pain specialist or pain clinic is always a good idea,” said Buck.

Medically reviewed by: Pat F. Bass III, MD, MS, MPH


  1. American Academy of Pain Medicine, Use of Opioids for the Treatment of Chronic Pain.

  2. Hooten WM, PAIN Publish Ahead of Print, 2015; DOI: 10.1097/j.pain.0000000000000170.