Approximately 15-19% of Canadians live with chronic, non-cancer pain, which is defined as pain that lasts for more than 3 months and that interferes with daily activities.
In a new clinical practice guideline released this week, doctors are being advised to reduce their prescribing of opioid medication to patients with chronic non-cancer pain. Canadians are the second highest users per capita of opioids in the world and the rates of opioid prescriptions and opioid-related hospital visits and deaths have steadily increased in recent years.
Some recommendations include:
- Non-drug and non-opioid pharmacotherapy should be considered first and optimized for patients with chronic non-cancer pain
- A trial of opioids for patients who have not responded to non-opioid treatment if patient does not have a current or past substance abuse problem or other psychiatric disorder
- For patients starting opioids, a dose of less than 50 mg morphine equivalents a day is recommended and it is strongly recommended that the total daily dose is under 90 mg a day (this is a change from the previous 2010 guideline which suggested that the max dose be 200 mg/day)
- A trial period of opioids to the lowest effective dose, potentially to none, for patients who are currently on 90 mg morphine equivalents a day or more, recognizing there are some patients who may need this tapering paused or abandoned
Led by the renowned Michael G. DeGroote National Pain Centre at McMaster University and funded by Heath Canada and CIHI, this guideline has been developed by an international team of clinicians, researchers and patients. The full guideline is available at: http://bit.ly/2q6tor2
In addition to the guideline, an app has also been created to help doctors and patients work together to find a solution to manage their pain. The app is available at: http://bit.ly/2qhywLU
Note: This guideline does not include recommendations on opioid use for acute pain, patients with cancer-related pain, those in palliative care or those currently undergoing treatment for opioid use disorder or opioid addiction