McMaster University is leading the way in supporting Canadian physicians in the appropriate use of opioids for chronic non-cancer pain with a new guideline centre. Uniquely, the centre has a public website which will give doctors instant access to the guidelines.
Increasing questions about the use of opioids for chronic pain have spurred Canadian colleges of physicians and surgeons to create a new guideline for opioid use with chronic non-cancer pain, states an article in the Canadian Medical Association Journal (CMAJ) today.
Opioid use in Canada has increased significantly, with a 50% jump in recorded prescription-opioid consumption between 2000 and 2004. Canada is now the world’s third-largest opioid consumer per capita.
For the first time, guidelines for physicians have been posted on a public website rather than being published only in a medical journal. The guidelines are the first product of McMaster’s new Michael G. DeGroote National Pain Centre, a group set up to oversee and update both these guidelines and others relevant to management of chronic pain. The centre was established with a $1.5 million donation by the philanthropist.
Dr. Norm Buckley, director of the centre, said the new guidelines will help physicians, particularly family doctors, who have been uncomfortable about when opioids are appropriate for chronic pain.
"Some patients who are not on opioids should be, and this will help physicians identify and care for them effectively, without sending them to wait months or years for specialty pain clinics," said Buckley, professor and chair of anesthesia for the Michael G. DeGroote School of Medicine and director of the Pain Management Centre at Hamilton Health Sciences’ Hamilton General Hospital.
"It will also help those of us who run pain clinics to be able to send patients back to their family doctors with the doctor being comfortable about when and how to use these drugs."
Buckley said the guidelines will also clarify if some patients may be receiving opioids when they shouldn’t. "These guidelines should assist in identifying those patients and helping to guide physicians away from opioids. The guideline also offers useful direction to physicians who may be managing patients with multiple problems including chronic pain."
The national guidelines have been developed over the past three years after Canadian medical regulators formed the National Opioid Use Guideline Group (NOUGG). Their goal was to help develop and implement a guideline to provide physicians with information to prescribe opioids safely and effectively to patients with chronic non-cancer pain.
"The Canadian guideline is intended to assist physicians with decisions to initiate appropriate trials of opioid therapy for patients with chronic non-cancer pain, to monitor long-term opioid therapy, and to detect and respond appropriately to situations of opioid misuse including addiction," writes Clarence Weppler, co-chair of NOUGG, and coauthors. "It was not designed to serve as a standard of care nor as a training manual."
The Canadian guideline targets primary-care physicians and medical and surgical specialists who manage patients with chronic non-cancer pain, however pharmacists, nurses and dentists may also find it useful. The guideline does not discuss treatment of chronic pain with non-opioids.