Chronic Pain

rxfiles.ca/pain

Our comprehensive guide to the management of chronic pain, with a focus on optimizing drug therapy. 

Chronic Pain Therapy

Prescribing Opioids Safely

Opioid Tapering

Opioid Use Disorder

Cannabinoids

Chronic Pain Therapy

Introduction

page 2

An overview of chronic pain therapy.

Top Pain Pearls

page 3

A collection of learnings, pearls, and things that may surprise you.

Principles of Chronic Pain Therapy

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.

Pain Colour Chart

page 6

Side-by-side comparisons of chronic pain pharmacotherapy using a 'traffic light' approach.

NSAID Drug Comparison Chart

page 18

Efficacy, indications, adverse effects, contraindications, drug interactions, monitoring parameters, dosing, and cost comparisons of various NSAIDs.

Opioid Drug Comparison Chart

page 19

Efficacy, indications, adverse effects, contraindications, drug interactions, monitoring parameters, dosing, and cost comparisons of various opioids.

2017 Canadian Opioid Prescribing Guideline Recommendations

page 20

Adapted with permission from the Canadian Medical Association.

Physical Activity Prescription

Evidence suggests that prescribing physical activity is more powerful than simply talking to patients about it.

Prescribing Opioids Safely

Introduction

page 22

Key messages for prescribing opioids.

An Approach to Prescribing Opioids Safely

page 23

Strategies for opioid prescribing, including safely initiating opioids, monitoring therapy, and exiting when necessary.

Navigating Opioids: Infographic

page 26

Reproduced with permission of the University of Toronto.

Take Home Naloxone

page 27

Describes who should receive a naloxone kit, naloxone patient education, and dosing, cost, drug coverage, formulations, and monitoring of naloxone.

Injectable Naloxone Infographic

page 28

Reproduced with permission of the University of Waterloo School of Pharmacy.

Intranasal Naloxone Infographic

page 29

Reproduced with permission of the University of Waterloo School of Pharmacy.

Urine Drug Screening

page 30

Describes who should undergo urine drug screening, why urine drug screening is valuable, and how urine drug screening should be implemented and interpreted.

Naloxone Patient Handout

Reproduced with permission of Taylor Raiche, BSP.

Opioid Tapering

Introduction

page 32

Key messages for tapering opioids.

An Approach to Tapering Opioids

page 33

Describes various opioid tapering strategies, and how to manage patient barriers.

Motivational Interviewing

page 35

How to guide patients towards change.

Opioid Tapering Patient Booklet

Discusses common questions patients have about tapering or discontinuing opioids, including a couple of true success stories describing 2 patient experiences.

Buprenorphine-Naloxone Patient Booklet

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.

Opioid Use Disorder

Introduction

page 36

Key messages for opioid use disorder.

Opioid Use Disorder: Overview and Drug Comparison Chart

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.

Buprenorphine-Naloxone Infographic

Top 12 important facts about buprenorphine-naloxone (SUBOXONE).

Opioid Agonist Therapy Colour Comparison Chart

Colour chart describing the comparative advantages and disadvanges of methadone and buprenorphine-naloxone (SUBOXONE). 

Buprenorphine-Naloxone Microdosing Infographic

A visual guide to microdosing buprenorphine-naloxone (SUBOXONE).

Harm Reduction

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. 

Cannabinoids

Introduction

page 40

Key messages for cannabinoid therapy. 

Cannabinoids: Overview and Drug Comparison Chart

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.

Cannabis Patient Booklet

Discusses common questions patients have about starting medical cannabis.

Support for the writing of this book and academic detailing on this topic was provided by the Saskatchewan Health Authority's Opioid Stewardship Program.