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May 2018

Chronic Non-Cancer Pain

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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Media

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 leads

  • Arun Radhakrishnan

    MSC, MD, CM, CCFP

    Dr. Arun Radhakrishnan is a family physician with a focused clinical practice in chronic non-cancer pain. He is an Assistant Professor with the Department of Family and Community Medicine at the University of Toronto and has a teaching affiliation with The Ottawa Hospital and the Elisabeth Bruyere Hospital. His research and education interests are in knowledge translation, mentoring and information and communication technologies in healthcare. He has led the development of a number of 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. 

    Dr. Radhakrishnan provided clinical leadership for the opioid therapy for chronic non-cancer pain, non-pharmacological and non-opioid options for chronic non-cancer pain and opioid use disorder topics.

Clinical Working Group

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.

Conflict of interest

The clinical lead received compensation for his role. 

Focus group and usability participants received a small token of appreciation (e.g. gift certificate).

Thank you

Thank you to everyone who supported the development of these tools and resources!

LHIN-specific resources


Additional resources



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