Chronic Pain
rxfiles.ca/pain
Our comprehensive guide to the management of chronic pain, with a focus on optimizing drug therapy.
Our comprehensive guide to the management of chronic pain, with a focus on optimizing drug therapy.
Introduction
page 2
An overview of chronic pain therapy.
page 3
A collection of learnings, pearls, and things that may surprise you.
page 4
Tips on how to empathize; set goals; use non-pharm approaches, prescribe artfully, problem solve & individualize; use a team approach; and treat special populations.
Managing acute-on-chronic-opioid pain is challenging; this chart offers tips for managing acute pain for patients already on codeine, fentanyl, heroin, hydromorphone, morphine, oxycodone, tapentadol, tramadol, methadone, or buprenorphine.
page 6
Side-by-side comparisons of chronic pain pharmacotherapy using a 'traffic light' approach.
page 18
Efficacy, indications, adverse effects, contraindications, drug interactions, monitoring parameters, dosing, and cost comparisons of various NSAIDs.
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Efficacy, indications, adverse effects, contraindications, drug interactions, monitoring parameters, dosing, and cost comparisons of various opioids.
page 20
Adapted with permission from the Canadian Medical Association.
Evidence suggests that prescribing physical activity is more powerful than simply talking to patients about it.
Infographic describing the top reasons to consider bup-nal for chronic pain patients.
page 22
Key messages for prescribing opioids.
page 23
Strategies for opioid prescribing, including safely initiating opioids, monitoring therapy, and exiting when necessary.
Managing patients with a blurred distinction between chronic pain and problematic opioid use.
page 26
Reproduced with permission of the University of Toronto.
page 27
Describes who should receive a naloxone kit, naloxone patient education, and dosing, cost, drug coverage, formulations, and monitoring of naloxone.
page 28
Reproduced with permission of the University of Waterloo School of Pharmacy.
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Reproduced with permission of the University of Waterloo School of Pharmacy.
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Describes who should undergo urine drug screening, why urine drug screening is valuable, and how urine drug screening should be implemented and interpreted.
Reproduced with permission of Taylor Raiche, BSP.
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Key messages for tapering opioids.
page 33
Describes various opioid tapering strategies, and how to manage patient barriers.
page 35
How to guide patients towards change.
Discusses common questions patients have about tapering or discontinuing opioids, including a couple of true success stories describing 2 patient experiences.
For patients with chronic pain who are unable/unwilling to taper their opioid, but who may benefit from the lower overdose risk of buprenorphine-naloxone, this booklet motivates patients to make the switch.
page 36
Key messages for opioid use disorder.
page 37
Compares buprenorphine/naloxone to methadone; describes various induction strategies; details dosing, adverse events, contraindications, drug interactions, monitoring, cost, and drug coverage of buprenorphine/naloxone & methadone; gives tips on managing special populations and clinical challenges.
Top 12 important facts about buprenorphine-naloxone (SUBOXONE) for opioid use disorder.
Colour chart describing the comparative advantages and disadvanges of methadone and buprenorphine-naloxone (SUBOXONE).
A visual guide to microdosing buprenorphine-naloxone (SUBOXONE).
Describes examples of evidence-based harm reduction for opioids, stimulants, tobacco, alcohol, cannabis, injecting drugs, and inhaling drugs. Presents an approach for guiding patients through behavioural change.
page 40
Key messages for cannabinoid therapy.
page 41
Provides an overview of cannabinoids, including definitions, efficacy, perspectives, and safety; details dosing, adverse events, contraindications, drug interactions, monitoring, cost, and drug coverage of various cannabinoid therapy options; describes how to prescribe cannabinoids safely.
Discusses common questions patients have about starting medical cannabis.
