title: Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population.
abstract: OBJECTIVE
  To provide family physicians with a practical clinical summary of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, developed by the National Opioid Use Guideline Group.
  
  
  METHODS
  Researchers for the guideline conducted a systematic review of the literature on the effectiveness and safety of opioids for chronic noncancer pain, and drafted a series of recommendations. A panel of 49 clinicians from across Canada reviewed the draft and achieved consensus on 24 recommendations.
  
  
  RESULTS
  Screening for addiction risk is recommended before prescribing opioids. Weak opioids (codeine and tramadol) are recommended for mild to moderate pain that has not responded to first-line treatments. Oxycodone, hydromorphone, and morphine can be tried in patients who have not responded to weaker opioids. A low initial dose and slow upward titration is recommended, with patient education and close monitoring. Physicians should watch for the development of complications such as sleep apnea. The optimal dose is one which improves function or decreases pain ratings by at least 30%. For by far most patients, the optimal dose will be well below a 200-mg morphine equivalent dose per day. Tapering is recommended for patients who have not responded to an adequate opioid trial.
  
  
  CONCLUSIONS
  Opioids play an important role in the management of chronic noncancer pain, but careful prescribing is needed to limit potential harms. The new Canadian guideline provides much-needed guidance to help physicians achieve a balance between optimal pain control and safety.
authors.affiliation: Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ont. kahanm@stjoe.on.ca
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.forename: Angela
authors.initials: A
authors.lastname: Mailis-Gagnon
authors.forename: Lynn
authors.initials: L
authors.lastname: Wilson
authors.forename: Anita
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects; D002170:Canada; D059350:Chronic Pain / Q000188:drug therapy*; D003061:Codeine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008403:Mass Screening; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000517:prevention & control; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010353:Patient Education as Topic; D012891:Sleep Apnea Syndromes / Q000139:chemically induced; D014147:Tramadol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D014147:Tramadol; D010098:Oxycodone; D004091:Hydromorphone; D003061:Codeine
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