Chronic Pain

  • Complete a baseline pain assessment which includes
    • History of the patient’s pain condition, including characterization and evolution
    • History of attempted therapies to date and their impact (pharmacologic, non-pharmacologic and substance use)
    • The patient’s pain experience (feelings, ideas, impact on function, expectations)
    • Relevant physical examination
    • Identification of key contextual elements that may affect assessment, management and response to therapy (eg work-related, mood disorders and other co-morbid conditions, previous pain conditions, addiction history, social context, suspected dependency/addiction and/or medication diversion)
  • Be familiar with the non-pharmacologic strategies for the management of chronic pain
  • Be aware of possible pharmacologic management options for chronic pain including the safe prescribing of the following therapeutic therapies:
    • Acetaminophen
    • NSAIDs (contraindications, GI protection, impact on current conditions)
    • Opiods (appropriate indications, opioid choice, opioid dependency risk assessment, surveillance and issues related to dose reduction when appropriate)

Core Resources

Allied Health Approaches to Chronic Pain Management

Pain BC. Allied Health Approaches to Chronic Pain Management: A Tool for Primary Care Providers. Available at: http://www.painbc.ca/node/463

Management of Chronic Non-cancer Pain

Reprinted with Permission from Centre for Effective Practice. (Updated May 2018). Management of Chronic Non-Cancer Pain (CNCP): Ontario. Toronto: Centre for Effective Practice.

The Opioid Manager

Reprinted with Permission from the Centre for Effective Practice (September 2017). Opioid Manager. Toronto. Centre for Effective Practice

Supplemental Resources

Guidelines for opioid therapy and chronic noncancer pain.pdf

Busse JW, Craigie S, Juurlink DN, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ May 08, 2017; 189 (18) E659-E666. doi: https://doi.org/10.1503/cmaj.170363

Understanding and Managing Pain: information for patients

Taylor N, et al. Understanding and managing pain: information for patients. The British Pain Society. (2010). Available at: https://www.britishpainsociety.org/static/uploads/resources/files/book_understanding_pain.pdf

Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments

Centre for Effective Practice in collaboration with Ontario College of Family Physicians and Nurse Practitioners’ Association of Ontario. Keeping your Patients Safe: A Guide to Primary Care Management of Mental Health and Addications-related Risks and Functional Impairments. February 2017

Simplified Guidelines for Prescribing Medical Cannabinoids in Primary Care.pdf

Allan GM, Ramji J, Perry D, et al. Simplified guideline for prescribing medical cannabinoids in primary care. Can Fam Physician. 2018; 64(2) 111-120.

Opioid Use Disorder Management.pdf

Korownyk C, et al. PEER Simplified Guideline: Managing Opiod Use Disorder in Primary Care. Alberta College of Family Physicians. May 2019. Available at: https://acfp.ca/wp-content/uploads/2019/05/OUD_Algorithm_WebReady.pdf

Opioid Tapering Template

Reprinted with Permission from Centre for Effective Practice. (February 2018). Opioid Tapering Template: Ontario. Toronto: Centre for Effective Practice.

Practice Tool Kit

Canadian guideline for safe and effective use of opioids for chronic non-cancer pain. Michael G. DeGroote National Pain Centre, McMaster University, 2010.