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May 2018

Management of Chronic Non-Cancer Pain Tool

Introduction

One in five adults report chronic pain (pain experienced every day for 3 or more months). Manage adult patients with chronic non-cancer pain (CNCP) using the Management of Chronic Non-Cancer Pain Tool.

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PODCASTS


Opioids for Chronic Non-Cancer Pain: A discussion with guideline editor Jason Busse

We spoke with Jason Busse, the main editor of the 2017 Canadian Guidelines for Opioids for Chronic Non-Cancer Pain about providers' frequently asked questions, the development of the guideline, and its nuances.

The Management of Chronic Non-Cancer Pain: All Cases

In this podcast, Dr. Arun Radhakrishnan walks us through a few fictional patient cases to highlight how the Management of Chronic Non-Cancer Pain tool can be used to support clinical decisions in managing patients suffering with pain.

EMR

Electronic Medical Record Resources

This tool is available as a custom form on Telus PS Suite and on OSCAR EMRs.

Information

About the Tool

Through a multidisciplinary and multidimensional approach, the Management of Chronic Non-Cancer Pain Tool is designed to assist family physicians and primary care nurse practitioners develop and implement a management plan for adult patients living with CNCP. The management of CNCP is an ongoing process that should be patient centred, collaborative and compassionate. This tool applies to pain conditions such as osteoarthritis, low back pain, musculoskeletal pain, fibromyalgia and neuropathic pain.

The tool is divided into the following five sections:

  1. Baseline and ongoing assessment
  2. Non-Pharmacological Therapy
  3. Non-Opioid Medications
  4. Opioid Medications
  5. Intervention Management and Referral

Where appropriate, primary care providers (PCPs) should use a combination of non-pharmacological and pharmacological options to build a comprehensive and personalized plan that incorporates the patient’s goals.

UPDATE: The CEP has updated the Management of Chronic Non-Cancer Pain Tool to reflect recommendations from the latest clinical practice guidelines. We conducted a literature search and an environmental scan for guidelines and resources published after the launch of the original tool.

What have we updated?

  • Recommendations based on new clinical practice guidelines such as the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.
  • Supporting materials and resources for patients and providers.
  • LHIN-specific resources.

The Management of Chronic Non-Cancer Pain Tool was developed using the CEP’s integrated knowledge translation approach. This approach ensures that providers are engaged throughout the development processes through the application of user-centered design methodology. Clinical leadership was provided by Dr. Arun Radhakrishnan. Clinical experts were also engaged to provide feedback on the management of chronic non-cancer pain.

The updated Management of Chronic Non-Cancer Pain Tool is one of several resources developed as part of the Knowledge Translation in Primary Care Initiative. This multi-year initiative was a collaboration between the Centre for Effective Practice (CEP), Ontario College of Family Physicians (OCFP), and Nurse Practitioners’ Association of Ontario (NPAO). Funded by the Ministry of Health and Long-Term Care, this initiative supported primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.

The need for a more effective approach to managing chronic non-cancer pain was identified by Ontario primary care providers as part of the Knowledge Translation in Primary Care Initiative. The Centre for Effective Practice enlisted the collaboration of clinical leads and a clinical working group.

Clinical Lead

  • Arun Radhakrishnan

    MSc, MD, CM CCFP

    Dr. Arun Radhakrishnan is a family physician with a focused practice in chronic pain and is the current co-chair of the Collaborative Mental Health Network and the Medical Mentoring for Addictions and Pain Network at the Ontario College of Family Physicians. He is also an adjunct assistant professor with the Department of Family and Community Medicine at the University of Toronto. 

    In 2013, Arun completed a Master’s degree at the University of Toronto in Health Services Research focusing on the value of information and communication technologies to enable knowledge translation activities in the areas of pain, mental health and addictions to support community physicians. His interests also include teaching and curriculum development around the integration of technology into the clinical encounter.

Clinical Working Group

A clinical working group comprised of nurses and physicians oversaw the development of this tool. Members include:

  • Mona Sawhney, nurse practitioner
  • Mireille St-Jean, family physician
  • Jeff Spence, family physician

Thank you to all of our members for their work.

Target End User Feedback and Expert Opinion

Local

LHIN-specific resources

To supplement the tool, we have compiled resources that are specific to each Local Health Integration Network (LHIN). Click on the LHIN to access its resources.



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