McMaster University

Michael G. DeGroote
National Pain Centre

Scope of Search

Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

13. Comparison with Other Guidelines

There are numerous other clinical practice guidelines that address the management of CNCP with opioids. In preparation for developing the Canadian Guideline, searches in MEDLINE and www.guideline.gov up to February 2009 were conducted with 15 relevant guidelines selected for a detailed evaluation. This evaluation determined that most guidelines were either focused on a specific health problem (fibromyalgia, neuropathic pain, osteoarthritis, low-back pain) or were out-of-date.

Three current guidelines are similar to the Canadian Guideline in terms of scope, population, development, sponsorship, recommendations, and presentation.

When work began on the Canadian Guideline, only one of these was published — the American Society of the Interventional Pain Physicians guideline, originally published in 2006 (Trescot 2006) and updated in 2008 (Trescot 2008): however, the target audience was interventional pain specialists.

In 2009, when the Canadian Guideline development was well underway, two other similar guidelines were published. The guideline of the American Pain Society/American Academy of Pain Medicine (Chou 2009) has additional recommendations not included in the Canadian Guideline: treatment of breakthrough pain, management of side effects, selection of short-acting versus long-acting preparations, special issues with methadone, and awareness of state laws. The Utah Department of Health guideline (Utah Department of Health 2009) is in fact a compilation of recommendations from six other guidelines on the management of CNCP with opioids. There are no major discrepancies between the Utah and the Canadian Guideline.