Apr 2024
Chronic Non-Cancer Pain
Introduction
Chronic non-cancer pain (CNCP) affects an estimated 20% of Canadians, and if not adequately addressed, can lead to significant suffering, loss of function, increased healthcare use, and additional complications including opioid and substance use disorders. For Canadians with chronic non-cancer pain, accessing specialist care can be extremely challenging; it is estimated that approximately 50% of patients living with chronic pain have had to wait six months or more for treatment.
Due to this urgency and lack of widespread, timely access to pain centres and specialists, primary care providers (PCPs) are often responsible for the management of complex patients with CNCP.
Manage adult patients with chronic non-cancer pain (CNCP) using CEP's Management of Chronic Non-Cancer Pain Web-based (HTML) Tool. For Telus PS Suite or OSCAR users, download and install CEP's EMR integrated, point-of-care, tool to use in your daily practice.
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About the tool
Telus PS Suite: Management of Chronic Non-Cancer Pain EMR Toolkit (2024)
The Canadian Best Practices for the Development of Effective Clinical Decision Support Systems for the Management of Chronic Pain in Primary Care initiative was established to identify and articulate national best practices for the development of Clinical Decision Support Systems (CDSS), specifically Electronic Medical Record (EMR)-integrated, CNCP management tools for use in primary care. Through an iterative process of synthesizing key evidence, engaging a National Advisory Committee composed of clinical experts, stakeholders, and primary care users, and by applying, testing, and refining the key principles in practice, the national best practices developed through this initiative provide practical, adaptable and actionable principles to apply and consider when developing EMR-integrated point-of-care CDSS tools. An existing EMR-integrated CNCP tool for Telus PS Suite was adapted to align with the identified best practices and reflects updated clinical evidence for managing patients living with CNCP. The Telus PS Suite: Management of Chronic Non-Cancer Pain EMR Toolkit is designed to to support primary care providers with chronic pain assessments, diagnosis, treatment, and management and can be used as a longitudinal CDSS to follow the patient through their treatment journey. The point-of-care Toolkit is divided into the following sections:
- Dashboard
- Assessment
- Management: General
- Management: Non-Pharmacological
- Management: Pharmacological
- Patient Resources
Web-based (HTML): Management of Chronic Non-Cancer Pain Tool (2018) & OSCAR: Management of Chronic Non-Cancer Pain EMR Toolkit (2018)
Through a multidisciplinary and multidimensional approach, the 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. 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.
The web-based and OSCAR tool is divided into the following five sections:
- Baseline and ongoing assessment
- Non-Pharmacological Therapy
- Non-Opioid Medications
- Opioid Medications
- Intervention Management and Referral
Telus PS Suite: Management of Chronic Non-Cancer Pain EMR Toolkit (2024)
The Telus PS Suite: Management of Chronic Non-Cancer Pain EMR Toolkit adaptation was developed using the CEP’s integrated knowledge translation approach. This approach ensures that providers are engaged through the application of user-centered design methodology. Clinical leadership was provided by Dr. Arun Radhakrishnan and Dr. Cameron Ross. A National Advisory Committee consisting of primary care providers, nurse practitioners, pain specialists and lived experience advisors were engaged to inform and provide feedback and guidance on the best practices and EMR tool adaptation. Primary care providers (family physicians and primary care nurse practitioners) were engaged throughout the tool development process (usability sessions, pilot testing) to support the EMR tool's refinement and evaluate the tool for readiness and uptake.
This multi-year project was funded by Health Canada’s Substance Use and Addictions Program (SUAP). The development of this tool was supported by eHealth Centre of Excellence (eCE).
Web-based (HTML): Management of Chronic Non-Cancer Pain Tool (2018) & OSCAR: Management of Chronic Non-Cancer Pain EMR Toolkit (2018)
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 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 Centre for Effective Practice enlisted the collaboration of clinical leads, a national advisory committe, clinician working group and target end-users. to support the development of a more effective approach to managing chronic non-cancer pain.
Clinical leads
Arun Radhakrishnan
MD, CM, MSC, CCFP
Dr. Arun Radhakrishnan is a family physician with a focused clinical practice in chronic pain. He is an Assistant Professor with the Department of Family Medicine at the University of Ottawa and the University of Toronto. He is affiliated with The Ottawa Hospital and the Elisabeth Bruyere hospital and is an investigator at the Bruyere Research Institute and the Equity in Health Systems Lab. His research and education interests are in knowledge translation mentoring and digital health technologies. He has led the development of several award-winning educational programs, clinical practice tools and resources to support primary care management of chronic pain. He is a past AMS Phoenix Fellow and is currently the Medical Director of the Adaptive Mentoring Networks with the Centre for Effective Practice.
Cameron Ross
MD, CCDP, FCFP
Dr Cameron Ross is a family physician with a broad spectrum clinical practice. He is an Assistant Professor of Family Medicine at UBC and Lead Faculty for EBM, UBC Postgraduate Dept of Family Practice, with ongoing private clinical and teaching practice in Chilliwack General Hospital and in Chilliwack BC. HIs education interests include EBM/Evidence Informed Healthcare and shared decision making in clinical practice, development of clinical decision support tools, knowledge translation and chronic pain. His most enjoyable work is mentoring and he has been the recipient of the UBC Peter Grantham Award for teaching excellence and the BC College of Family Physicians teaching award. He has been physician lead in many workshops on chronic pain and procedural pain management and was the family practice representative on the BCMQI committee developing provincial procedural pain management standards. He was a reviewer and contributing author to the PAIN BC Foundations course and one of the working group authoring the latest BC Pain guidelines. When not working he is a spouse, father and grandfather.
National Advisory Committee (2022-2024)
A National Advisory Committee comprised of nurses, physicians and individuals with lived experience oversaw the development of the Canadian Best Practices for the Development of Effective Clinical Decision Support Systems for the Management of Chronic Pain in Primary Care, Pratiques exemplaires canadiennes pour l’élaboration de systèmes d’aide à la décision clinique efficaces en matière de gestion de la douleur chronique dans les soins primaires and the Telus PS Suite: Management of Chronic Non-Cancer Pain EMR Toolkit adaptation.
Members include:
- Dr. Arun Radhakrishnan
- Dr. Cameron Ross
- Dr. Samir Gupta
- Dr. Lori Montgomery
- Jennifer Daly-Cyr
- Dr. Peter Selby
- Dr. Virginia McEwen
- Ibrahim Omar
- Dwayne Patmore
- Owen Adams
- Dr. Maureen Allen
- Dr. Norm Buckley
- Barbara Eddy
Thank you to all of our members for their work.
Clinical Working Group (2018)
A clinical working group comprised of nurses and physicians oversaw the development of this tool. Members include:
- Mona Sawhney, PhD, NP
- Mireille St-Jean, MD
- Jeff Spence, MD
Thank you to all of our members for their work.
Target End User Feedback and Expert Opinion
Resources & Supports
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Canadian Best Practices for the Development of Effective Clinical Decision Support Systems for the Management of Chronic Pain in Primary Care (2024)
Practical recommendations
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Pratiques exemplaires canadiennes pour l’élaboration de systèmes d’aide à la décision clinique efficaces en matière de gestion de la douleur chronique dans les soins primaires
Recommandations pratiques
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Chronic Non-Cancer Pain Tool (2018) Appendices
A: Non-pharmacological treatments, B: Non-opioid medications, C: Opioid prescribing and monitoring for chronic non-cancer pain,
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Getting Back on the Road of Life
Patient handout
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SMART Goals for Pain Management
Patient handout
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Urine Drug Screening (UDS)