The Centers for Disease Control and Prevention has issued new guidance for clinicians on how and when to prescribe opioids for pain. Released Thursday, this revamps the agency's 2016 recommendations which some doctors and patients have criticized for promoting a culture of austerity around opioids.

CDC officials say that doctors, insurers, pharmacies and regulators sometimes misapplied the older guidelines, causing some patients significant harm, including "untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose, and [suicide]," according to the updated guidance.

The 100-page document and its topline recommendation serve as a roadmap for prescribers who are navigating the thorny issue of treating pain, including advice on handling pain relief after surgery and managing chronic pain conditions, which are estimated to affect as many as one in every five people in the U.S.

The 2016 guidelines proved immensely influential in shaping policy — fueling a push by insurers, state medical boards, politicians and federal law enforcement to curb prescribing of opioids.

The fallout, doctors and researchers say, is hard to overstate: a crisis of untreated pain. Many patients with severe chronic pain saw their longstanding prescriptions rapidly reduced or cut off altogether, sometimes with dire consequences, like suicide or overdose as they turned to the tainted supply of illicit drugs.