writing a prescription for strong pain medications .”
Canadian physicians currently have two main guidelines to refer to , the 2010 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain and the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain .
The 2016 CDC Guidelines encourage the use of non-pharmacologic , conservative care and consideration of alternatives including behavioural changes and non-addictive painkillers . The Foundation for Chiropractic Progress summarized several recent shifts in the American guidelines :
“ When you look at the IOM report , the FDA guidelines , and the CDC guidelines , all of them recommend that non-opioid and non-pharmacologic approaches be the first approaches in dealing with chronic pain … with recommendations that we provide the treatment of greatest benefit — and that opioids are not the first line therapy for chronic pain .” 12
The Canadian Guideline is being updated in 2017 and will be much more cautious than the 2010 Guidelines about the use of opioids for chronic non-cancer pain , encouraging other therapies instead . The Draft Recommendations & Rationales for the 2017 Canadian Opioid Guideline was released on January 30 , 2017 and has several recommendations including :
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Optimization of non-opioid pharmacotherapy and nonpharmacological therapy before considering opioids ,
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Limiting opioid doses to 50mg morphine equivalents daily , and tapering current patients down to this dose or off opioids if possible , and
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When patients experience difficulty in tapering down from a higher dose of opioids , enrolling them in a formal multidisciplinary program which includes collaboration with health practitioners who can offer physical therapy .
When developing these guidelines , the Steering Committee has been guided by consultations with practitioners and patients , and a desire to improve efficacy of care and the patient experience . Their Values & Preferences Statement outlines that “ when patients experience severe nausea , vomiting , or constipation as a result of opioid use , these adverse effects are almost as important as pain relief , and thus may be more important than small degrees of pain relief .” This commitment to the patient experience combined with low evidence for the benefits of opioids and strong evidence of harms is leading to a major change in the Canadian Guidelines in 2017 .
MOVING FORWARD
Within the context of our healthcare system , chiropractors can help chronic pain patients avoid the negative effects of opioids , whether they are currently using them or not :
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Chiropractors offer a front line nonpharmacological approach to chronic MSK pain management .
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When a patient is tapering off of opioids , whether due to their own preferences or as directed by a physician or nurse practitioner , chiropractic care can help them successfully reduce their reliance on opioids .
Canada ’ s Opioid Action Plan
Health Canada ’ s Opioid Action Plan includes a Joint Statement of Action to Address the Opioid Crisis , a document which includes commitments from federal and provincial governments and health organizations across the country .
One of only five health professions invited to be a signatory of the federal Opioid Action Plan , the Canadian Chiropractic Association was included because of chiropractors ’ focus on reducing the use of opioids by leveraging non-opioid pain management strategies . The CCA made a commitment in the Joint Statement to develop evidence-based professional practice recommendations and guidelines to facilitate the appropriate triage and referral of Canadians suffering from chronic and acute musculoskeletal conditions and reduce reliance on opioids . This document will include key recommendations for the appropriate role of chiropractic care when choosing alternatives to opioids , and will be submitted to the government by June 2017 .
These recommendations will complement the 2017 Opioid Guidelines which advise physicians and nurse practitioners to maximize the use of
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