McMaster University

Michael G. DeGroote
National Pain Centre

Scope of Search

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

1. Core Concepts

Many contributors engaged in developing the Canadian Guideline:

  • Canadian medical regulatory authorities were responsible for the initiation and oversight.
  • A Research Group searched, appraised, and synthesized the evidence into recommendations.
  • A National Advisory Panel reviewed, critiqued, and reached consensus on the recommendations.
  • A National Faculty continues to assist with building a plan for active implementation.
  • McMaster University created the Michael G. DeGroote National Pain Centre that will assume responsibility for keeping the Canadian Guideline current, working collaboratively with national partners and alerting clinicians about new evidence.

Through the countless hours of research, writing, reviewing, revising, discussing, and debating that culminated in this Canadian Guideline, the notion of a common ground at times seemed elusive. Even though the landscape of chronic non-cancer pain management appeared to be characterized more by differences of opinion and divergent views than consensus, a common ground that contributors do share emerged from this collaborative process. It seemed a fitting beginning to describe the core concepts that represent contributor’s values and beliefs:

  • Patients with chronic pain have a right to be treated.
  • Opioids can be an effective treatment for chronic non-cancer pain (CNCP) and should be considered.
  • Opioids are not indicated in all CNCP conditions, and medication alone is often insufficient to manage CNCP; other effective treatments should also be considered.
  • Opioid use does present risks and potential harms — prescribers and dispensers have an obligation to assess risks and minimize harms.
  • Not enough is known about the long-term benefits, risks, and side effects of opioid therapy; more research is needed in these areas.
  • Many clinicians can play a role in managing CNCP; patient care is improved with good communication and collaboration between clinicians across disciplines within primary care, and between primary care and specialty care.
  • Guidelines are necessary but not sufficient to change practice — guidelines need to be actively implemented to practice and supported with useful, easy-to-use tools.
  • Across Canada, systemic barriers exist that could reduce Canadian Guideline compliance. Implementation efforts should include raising awareness with multiple-system stakeholders about the role they can play in improving the effectiveness and safety of opioid prescribing.
  • Guidelines provide information and recommendations but are not to be considered training manuals. Some recommendations in the Canadian Guideline may require some clinicians to acquire specific knowledge and skills.
  • Overdose, addiction, and opioid diversion are problems associated with opioid use — striking a balance between effective treatment of chronic pain and preventing harms is a challenge.
  • Patients have an important role to play in ensuring opioids are used safely. Implementation should include education of patients and the general public about the potential benefits and harms of opioids and their role in using opioids safely and effectively.