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

Summary of Recommendations

Cluster 4: Treating Specific Populations with LTOT

No. Recommendation Keyword
R17 Opioid therapy for elderly patients can be safe and effective (Grade B) with appropriate precautions , including lower starting doses, slower titration, longer dosing interval, more frequent monitoring, and tapering of benzodiazepines (Grade C). Elderly patients
R18 Opioids present hazards for adolescents (Grade B). A trial of opioid therapy may be considered for adolescent patients with well-defined somatic or neuropathic pain conditions when non-opioid alternatives have failed, risk of opioid misuse is assessed as low, close monitoring is available, and consultation, if feasible, is included in the treatment plan (Grade C). Adolescent patients
R19 Pregnant patients taking long-term opioid therapy should be tapered to the lowest effective dose  slowly enough to avoid withdrawal symptoms, and then therapy should be discontinued if possible (Grade B). Pregnant patients
R20 Patients with a psychiatric diagnosis are at greater risk for adverse effects from opioid treatment. Usually in these patients, opioids should be reserved for well-defined somatic or neuropathic pain conditions. Titrate more slowly and monitor closely; seek consultation where feasible (Grade B). Co-morbid psychiatric diagnoses