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  • New Canadian Guidelines Seek to Move Physicians Toward Nondrug Treatments for Pain

    Add the Canadian Medical Association to the list of organizations shifting guidelines away from opioids in the treatment of chronic noncancer pain. In a set of updated recommendations that authors describe as consistent with US Centers for Disease Control and Prevention (CDC) guidelines, Canadian physicians are being urged to pursue nonopioid and nondrug treatments as a firstline approach.

    The guidelines, published in the May 8 edition of CMAJ, are an update to opioid prescription guidelines released in 2010, in which "almost all supported the prescribing of opioids," according to the new guidelines' authors. The new recommendations take a markedly different position, advocating not just for nondrug approaches but also for lower dosages when opioids must be used, as well as for tapering programs for patients receiving high-dosage therapy of 90 milligrams or more daily.

    Researchers conducted a systematic review of literature that included analysis of multiple prescription and pain treatment guidelines, including the CDC resource. Guideline development also included meetings with stakeholders from law enforcement, medical regulation, pharmacy patient advocacy, addiction medicine, pain medicine, and several Canadian government agencies.

    In the end, 10 guidelines were developed and tagged as being either a "strong recommendation," meaning that the recommendation is appropriate for almost everyone, or a "weak recommendation," meaning that the guidance is applicable to a majority of patients but may not be appropriate for an "appreciable minority." The strong recommendations include use of nonopioid approaches, particularly with patients with substance-use disorder, as well as prescriptions for fewer than 90 milligrams per day when opioids are indicated. Authors also strongly recommend "a formal multidisciplinary program" that may include physical therapists to assist patients attempting to taper down opioid use.

    Authors describe the guidelines as "consistent" the CDC guidelines, which have been endorsed by some provincial regulatory agencies. The new recommendations are also in sync with APTA's #ChoosePT campaign, which has been adopted by the Canadian Physiotherapy Association in a collaborative effort to educate the public about physical therapy as a safe alternative to opioids for the management of pain.

    Comments

    • Hi nice it has to be implemented world wide.

      Posted by sundar on 5/20/2017 2:49 AM

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