Tackling Undertreatment

New guidelines have been drawn up to help Canadian physicians gain understanding of the appropriate use of opioids for chronic noncancer pain (CNCP). The purpose of these new guidelines is to address the undertreatment of chronic pain and the burgeoning issue of opioid medication misuse.

Collaborative Effort

The guideline was developed through a collaborative effort of various medical bodies in Canada and can be seen online at: http://nationalpaincentre.mcmaster.ca/opioid/ "Canadian physicians asked for clear, evidence-based guidance to safely manage opioid treatment for patients with [CNCP]," said Andrea D. Furlan, MD, PhD, who is affiliated with the University of Toronto in Ontario. "The Canadian Guideline provides 24 recommendations based on evidence and consensus of experts, although it is not a policy or a standard of practice," she explained.

Dr. Furlan says that physicians are afraid to prescribe opioids because they are fearful of complications, adverse events, overdose, addiction, and possible misuse. However, Furlan states that if patients are given proper instructions and physicians monitor patients with care, these issues should not arise. The guideline acts as a resource for doctors and dispenses all the advice they need concerning the issue of opioid medications.

Appropriate Recommendations

The derivation of the guideline is found in a review of 184 research studies which helped suggest appropriate recommendations for opioid use. The Canadian Opioid Guideline specifies four questions a physician should consider before prescribing opioids to patients with CNCP:

"*What should I do before writing a prescription for opioids?

 *How do I titrate the dosage of opioids?

 *What should I do to ensure patient safety?

 *When do I stop a patient's opioid therapy?"

Five Sections

These questions are answered through a series of 24 recommendations grouped into five sections. The guideline follows two similar efforts which were published in the United States. Furlan says that the Canadian guideline doesn't contain all the recommendations that are in the guideline produced by the American Pain Society/American Academy of Pain Medicine. The additional American recommendations include advice on treating breakthrough pain, how to manage adverse effects, when to choose short over long-acting medications, advice on methadone, and practical knowledge relating to state laws.

An article about the guidelines which appeared in the Canadian Medical Association Journal described some gaps in what the medical community knows about opioid use for noncancer pain. The article states that more studies need be done, "on the treatment of fibromyalgia pain and chronic headache with opioids other than tramadol, and no useful literature exists on opioid treatment for chronic visceral pain," explained the authors of the article.

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