Guideline - Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

The number of patients with CNCP [chronic non-cancer pain] is significant and growing. Responsibility for care of these patients should rest with primary-care providers who use consultation/referral for specialized input selectively. With this in mind, the intent of the Canadian Opioid Guideline is to improve comfort and confidence in using opioids for CNCP among clinicians, particularly primary-care providers, while preserving patient and public safety. To achieve these ends, recommendations and practice tools are both supported by the best available evidence or expert opinion consensus, and also feasible in day-to-day practice. [Source: Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, Part A, page 5, April 30, 2010]

The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain is a national, evidence-based guideline that provides 24 practice recommendations to assist physicians who are initiating opioid therapy, conducting an opioid trial and/or montoring long-term opioid therapy.

The guideline is not intended as a policy or standard of practice, but as a practical resource to provide Canadian physicians with the best available information, research and consensus of opinion on this topic.

Complete versions of the guideline are available in English in electronic formats from the Michael G. DeGroote National Pain Centre at McMaster University. Practice tools and additional resources are available there also. A French edition of these documents will be completed as soon as possible.

"Opioids for chronic non-cancer pain: a new Canadian guideline" is an eight page summary available from the Canadian Medical Association Journal.

Other resources are listed below.

In 2007, medical regulatory authorities from across Canada formed the National Opioid Use Guideline Group (NOUGG) to develop the guideline. NOUGG completed itswork in 2010. It was supported by a research team and a national advisory panel of pain specialists, family physicians, addiction experts, pharmacists, academics, nurses and patient representatives. The College of Physicians and Surgeons of Newfoundland and Labrador participated in developing the guideline. Dr. Robert Young served on NOUGG while Dr. John Collingwood and Dr. Lydia Hatcher served on the advisory panel.

Resources

• The Canadian Guideline for the Safe and Effective Use of Opioids for Chronic Non-Cancer Pain(Michael G. DeGroote National Pain Centre)
• Site Map (Table of Contents) for the opioid guideline site.
• Canadian Medical Association Journal (CMAJ): "Opioids for chronic noncancer pain: a new Canadian guideline". 
• Practice Toolkit for the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain is available from the National Pain Centre in pdf at this link: 

http://nationalpaincentre.mcmaster.ca/documents/practicetoolkit.pdf    The toolkit includes a variety of decision-making tools including information for physicians to use before prescribing opioids for patients, in selecting the right opioid and titrating effectively, for monitoring for safe and effective use, and for tapering opioids properly. The tool kit also includes Opioid Manager.

• Opioid Manager:  A practical tool (one page, two-sided) to guide the initiation and monitoring of opioid therapy for patients with chronic, non-cancer pain. Based on the Canadian Guideline for the Safe and Effective Use of Opioids for Chronic Non-cancer Pain. Available in English, French, Spanish and Portuguese.
• Opioid Information for Patients 
• New:  "Are you thinking about taking opioids for your pain?" is a two-page pamphlet from the Michael G. De Groote National Pain Centre.