2017
DOI: 10.1503/cmaj.170363
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Guideline for opioid therapy and chronic noncancer pain

Abstract: KEY POINTS• We recommend optimization of nonopioid pharmacotherapy and nonpharmacologic therapy, rather than a trial of opioids, for patients with chronic noncancer pain.

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Cited by 576 publications
(650 citation statements)
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References 42 publications
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“…It is well known that patients with concurrent psychiatric conditions are at increased risk for adverse outcomes related to opioid prescribing, and current Canadian guidelines recommend against opioid prescribing until the active psychiatric disorder has been stabilized. 24 Our observation that psychiatric conditions were a common cause for opioid prescribing by …”
Section: Limitationsmentioning
confidence: 94%
“…It is well known that patients with concurrent psychiatric conditions are at increased risk for adverse outcomes related to opioid prescribing, and current Canadian guidelines recommend against opioid prescribing until the active psychiatric disorder has been stabilized. 24 Our observation that psychiatric conditions were a common cause for opioid prescribing by …”
Section: Limitationsmentioning
confidence: 94%
“…[6][7][8][9] However, a large US outpatient study found that only 0.12% of chronic pain consultations involved pain specialists. 10 While less expensive, GP care does not become cost effective until it addresses physical disability alongside pain-related thoughts, emotions and behaviours.…”
Section: Introductionmentioning
confidence: 99%
“…universal precautions) resemble an assortment of opioid substitution therapy approaches. However, these strategies fail to reliably predict or identify abusers or mitigate risks, 3,6 and are rarely implemented by GPs. 24 When initiated with dose reduction, risk mitigation strategies do not worsen pain control or quality of life.…”
Section: Introductionmentioning
confidence: 99%
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“…19 Problematic use of substances is also a concern 19 ; Canada has the second highest per capita rate of opioid prescribing in the world, 20 and moderate quality evidence suggests that prescription of opioids for chronic non-cancer pain is associated with a 5.5% risk of opioid use disorder. 21 Despite its enormous costs, until recently, less than 0.25% of all health research funding was directed toward chronic pain in Canada. 22 In 2014, as part of its strategy for patient-oriented research (POR), the Canadian Institutes of Health Research (CIHR) called for proposals to establish collaborative national research networks focusing on chronic diseases.…”
Section: Introductionmentioning
confidence: 99%