Canadian guideline for safe and effective use of opioids for chronic non-cancer pain: implications for pain physicians.

Abstract

1Department of Family Medicine, University of Toronto; Addiction Medicine Service, Department of Family Medicine, St Joseph’s Health Centre; 2Department of Medicine, Division of Physiatry, Institute of Medical Science, University of Toronto; Comprehensive Pain Program, Toronto Western Hospital; ACTION Ontario, Centre for the Study of Pain, Toronto; 3Department of Psychiatry, McMaster University, Hamilton; Canadian Memorial Chiropractic College, Toronto, Ontario Correspondence: Dr Meldon Kahan, Department of Family Medicine, East Wing, 30 The Queensway, St Joseph’s Health Centre, Toronto, Ontario M6R 1B5. Telephone 416-530-6860, fax 416-530-6106, e-mail kahanm@stjoe.on.ca Chronic pain is a serious public health concern, causing widespread suffering and disability, and increased health care costs (1). Potent opioids have become a mainstay of chronic pain treatment, and both the number of patients taking opioids and the mean dose per patient have increased substantially in North America. Unfortunately, this has been accompanied by marked increases in opioid-related deaths, diversion, misuse and addiction, generating concern among the public and the medical profession. For a guideline to be credible, it should be based on a comprehensive search of controlled trials and other studies, supplemented by the perspectives of experienced clinicians and opinion leaders. It should address questions important to public health and provide practical guidance to clinicians. These goals have been achieved in the recently published “Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain” (2). Under the umbrella of the Federation of Medical Regulatory Authorities of Canada, the National Opioid Use Guideline Group was created in 2008 to collaborate on guideline development and implementation. A core research group was formed, which conducted a systematic review of the effectiveness of opioids for chronic noncancer pain (CNCP), as well as focused reviews on topics such as medical complications of opioids and use of opioids in specific populations. The core group wrote an initial draft of the guideline. A 49-member panel that included physicians from family medicine, physiatry, neurology and addiction medicine, and various other health care providers, reviewed the draft and provided feedback through a structured approach. All major regions of Canada were represented on the panel, which included members of national organizations such as the Canadian Pain Society. The panel achieved consensus on 24 recommendations. Some highlights of the guideline are provided below.