New ASRA Guidelines Address Anesthesiology, Chronic Pain, and Screening for Cannabis Before Surgery

The American Society of Regional Anesthesia and Pain Medicine (ASRA) released new guidelines in early 2023 on the management of perioperative patients on cannabis and cannabinoids. The new ASRA guidelines – the first of their kind in the United States – set forth 21 recommendations covering preoperative, intraoperative, and immediate postoperative care considerations.

Chronic pain is one of the most common indications for medical cannabis prescriptions, and both cannabis and opioids are commonly used for pain management, and often together. Thus, it naturally follows that providers are concerned with if, and how, these substances interact with one another in the preoperative, perioperative, and postoperative settings.

To bring our stakeholders a full view of these new guidelines, we have compiled a number of articles which address them:

Pain Management Collaboratory Working Toward Whole Person Approach in the VA and DoD

With up to 44% of soldiers experiencing chronic pain, and 15% using opioids after a combat deployment, the implementation and evaluation of nondrug approaches for the management of pain is urgently needed in the military. In 2017, in order to address this issue, the National Institutes of Health forged a partnership with the U.S. Department of Defense (DoD) and U.S. Department of Veteran’s Affairs (VA) to establish the Pain Management Collaboratory (PMC). The PMC supports a shared resource center and 11 large-scale pragmatic clinical trials, enrolling more than 8,200 study participants across 42 veteran and military health systems. Central to the PMC partnership is whole person health—a central focus of NCCIH’s current Strategic Plan—recognizing that health exists across multiple interconnected body systems and domains: biological, behavioral, social, and environmental. While PMC’s research specifically targets the military community, their growing body of evidence will ultimately benefit the general public as well.

VA Aims to Help Veterans and the Public to Break the Pain Cycle
The VA has released a toolbox of information, resources, and tools titled Chronic Pain 101: How to Break the Cycle. Developed for both Veterans the patients within the general public, the toolbox includes information on exercise and physical therapy, healthy lifestyle choices, communication skills, cognitive behavioral therapy, management of opioid therapy, psychological factors, and more.

NIDA Releases Compilation of CME/CE Courses on Pain, Opioids, and Substance Use Disorder

In order to provide access to relevant CME/CE courses on topics related to pain management, opioid prescribing, overdose, and stigma, the National Institute on Drug Abuse (NIDA) has compiled a list of relevant education for providers. In addition to numerous courses on opioid use disorder and stigmatizing language, the courses also focus on opioid prescribing, naloxone use in the school setting, acute pain management, safe prescribing for dental pain, adolescent use, motivational interviewing, and more.

CDC Releases Guidance and Resources on How to Implement 2022 Opioid Guideline

In order to aid clinicians and health systems, CDC has released updated information and resources on how to implement its 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline). The 2022 Clinical Practice Guideline includes 12 recommendations for clinicians providing pain care for outpatients aged 18 years or older with acute pain (duration less than 1 month), subacute pain (duration of 1-3 months), or chronic pain (duration of more than 3 months). The 12 recommendations help clinicians to (1) determine whether or not to initiate opioids for pain, (2) select opioids and determine dosages, (3) decide duration of initial prescription and conduct a follow-up, and (4) assess risk and address potential harms of opioid use. The clinical practice guideline provides recommendations only, and it does not replace clinical judgment and individualized, patient-centered decision-making.