PEER simplified chronic pain guideline

Abstract

Objective To develop a clinical practice guideline to support the management of chronic pain, including low back, osteoarthritic, and neuropathic pain in primary care. MethodsThe guideline was developed with an emphasis on best available evidence and shared decision-making principles. Ten health professionals (4 generalist family physicians, 1 pain management-focused family physician, 1 anesthesiologist, 1 physical therapist, 1 pharmacist, 1 nurse practitioner, and 1 psychologist), a patient representative, and a nonvoting pharmacist and guideline methodologist comprised the Guideline Committee. Member selection was based on profession, practice setting, and lack of financial conflicts of interest. The guideline process was iterative in identification of key questions, evidence review, and development of guideline recommendations. Three systematic reviews, including a total of 285 randomized controlled trials, were completed. Randomized controlled trials were included only if they reported a responder analysis (eg, how many patients achieved a 30% or greater reduction in pain). The committee directed an Evidence Team (composed of evidence experts) to address an additional 11 complementary questions. Key recommendations were derived through committee consensus. The guideline and shared decision-making tools underwent extensive review by clinicians and patients before publication.This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link. This article has been peer reviewed.

Mapping guideline‐informed care for chronic non‐specific low back pain with the biopsychosocial approach: A rapid review

“…In terms of “completeness of reporting,” eight guidelines were rated as medium quality, 18,19,21,24,26,28–30 four as high quality, 17,20,23,25 and three as low quality 22,27,31 . When assessed against the ‘clinical validity’ criterion, most included guidelines were rated as medium quality ( n = 8), 18,19,24,26–30 followed by high quality ( n = 5), 17,20,21,23,25 and low quality ( n = 2) 22,31 . The ‘overall quality’ of included guidelines was rated as medium for nine guidelines, 18,19,21,24,26–30 high for four guidelines, 17,20,23,25 and low for two guidelines 22,31 …”

Chronic noncancer pain management

“…As a last resort, family physicians might prescribe opioids, despite current evidence or even opinion against prescribing. 8,16 Finding effective and cost-efficient alternative ways to manage chronic pain in an outpatient setting is therefore crucial. 41,42 Our program demonstrates that an RN-led chronic noncancer pain intervention program within a family medicine practice is feasible and shows promise for improving pain-related outcomes and, importantly, reducing opioid use.…”

“…1 For chronic pain management, nonpharmacologic options and multidisciplinary care are recommended as gold standards. [6][7][8] Self-management is central to such programs, as it empowers patients to adopt behaviour, strategies, and skills to improve their quality of life. [9][10][11] In Canada most multidisciplinary clinics for chronic pain are located in hospitals, and access can be limited by long wait times.…”

Merging clinical practice guidelines for chronic pain with insights from noninvasive neuroimaging

“…1 In an extensive review of the best available evidence, Korownyk et al acknowledged that "despite the prevalence of chronic pain and the subsequent search for effective therapies, an optimal approach in primary care management remains elusive." 2 Now what? Do we abandon ineffective therapies and develop new strategies, perhaps by incorporating data from noninvasive neuroimaging and fully embracing a biopsychosocial model of care?…”