2017 Canadian Guideline for Opioids for
Chronic Non-Cancer Pain, Chronic,…
Chronic, Non-cancer Pain
- pain ≥ 3 months
- no current diagnosis of cancer
R1 - Optimize non-opioid analgesics
- Strong Recommendation: We recommend optimization of non-opioid pharmacotherapy and non-pharmacological therapy, rather than a trial of opioids
Any one of:
- Active Substance Use Disorder?
- Past history of Substance Use Disorder?
- Active Psychiatric Disorder?
R2 - Initiation trial of opioids
- Weak Recommendation: We suggest adding a trial of opioids rather than continued therapy without opioids.
R6 - Initiation dose < 90mg morphine equivalents daily
- Strong Recommendation: We recommend restricting the prescribed dose to less 90mg morphine equivalents daily rather than no upper limit or a higher limit on dosing
R7 - Initiation dose < 50mg morphine equivalents daily
- Weak Recommendation: For patients with chronic noncancer pain who are beginning opioid therapy, we suggest restricting the prescribed dose to less than 50mg morphine equivalents daily