Cited by 707Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

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Guideline for opioid therapy and chronic noncancer pain

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Busse, Jason W., Craigie, Samantha, Juurlink, David N., Buckley, D. Norman, Wang, Li, Couban, Rachel J., Agoritsas, Thomas, Akl, Elie A., Carrasco-Labra, Alonso, Cooper, Lynn, Cull, Chris, da Costa, Bruno R., Frank, Joseph W., Grant, Gus, Iorio, Alfonso, Persaud, Navindra, Stern, Sol, Tugwell, Peter, Vandvik, Per Olav, Guyatt, Gordon H.·2017·Canadian Medical Association Journal

DOI 10.1503/cmaj.170363PMC PMC5422149

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Abstract

Chronic noncancer pain includes any painful condition that persists for at least three months and is not associated with malignant disease.[1][1] According to seven national surveys conducted between 1994 and 2008, 15%–19% of Canadian adults live with chronic noncancer pain.[2][2] Chronic

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GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
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Health professional perceptions of a pharmacist-led interprofessional chronic pain clinic
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Opioid Prescribing for Noncancer Patients—Issues of Drug Therapy Safety: Results from a German Study Based on Routine Data
Lappe, V., Grandt, D., Marschall, U., & Schübert, I. (2024) · Pharmacoepidemiology · doi:10.3390/pharma3010007 · Cited by 1
“The topics analyzed have been chosen due to the recommendations and warnings In the guidelines [14,15,17–19 Drugs were assessed by the anatomical therapeutic chemical (ATC) code.”
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Perceptions in Orthopedic Surgery on the Use of Cannabis in Treating Pain: A Survey of Musculoskeletal Trauma Patients—Results From the Canadian POSIT Study
Gjorgjievski, M., Madden, K., Bullen, C., Koziarz, F., Koziarz, A., Cenic, A., Li, S., Bhandari, M., & Johal, H. S. (2024) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0000000000002848 · Cited by 1
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Thille, P., Tobin, A., Evans, J. M., Katz, A., & Russell, G. M. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02520-3 · Cited by 1
“C added that the new physician was following newest guidelines endorsed by their licensure bodies regarding prescriptions of opioids, which recommends tapering of higher opioid doses for people taking the medication for chronic, non-cancer pain [42].”
Background
Beyond Opioid Sparing: A Qualitative Study with Family Physicians and Nurse Practitioners in British Columbia
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Ashoorion, V., Sood, T., Muneer, S., Busse, J. W., Rice, D. B., Swidrovich, J., Majid, U., Abesteh, J., Mao, R. Q., & Sud, A. (2025) · Canadian Journal of Pain · doi:10.1080/24740527.2025.2499553 · Cited by 1
“The 85% threshold, a conventional value also used for a similar purpose in the Canadian Opioid Prescribing Guidelines, 35 was applied for consistency since we used studies included by the opioid guideline team.”
Self-citation
The Impact of a Novel Methodological Process for Needling Scars, Fascia, and Muscles in the Management of Myofascial Dysfunction and Chronic Pain in a Population Living With Social and Health Inequities: Quantitative Findings From a Longitudinal Observational Pilot Study
Nguyen, L., Eddy, B. L., West, N., Bone, J., Currie, L. M., & Lauder, G. (2025) · Pain Research and Management · doi:10.1155/prm/8567447 · Cited by 1
A systematic review and meta-analysis to identify vertical limits for a high-dose opioid therapy
Dickmann, F., Stingl, J., Lampert, A., Mücke, M., Peuckmann‐Post, V., Magerl, W., Rolke, R., & Weber, S. (2025) · Neurological Research and Practice · doi:10.1186/s42466-025-00437-5 · Cited by 1
“There have been attempts to incorporate the correlation of higher dosages with increase in adverse events (Busse et al. [38]; Häuser et al. [39]) as well as duration of the treatment and polypharmacy (Musich et al. [25]).”
Patient‐ and Clinician‐Related Factors Associated With the Reduction in Opioid Use Among Adults With Chronic Non‐Cancer Pain: A Systematic Review
Marcelo, A. C., Hilmer, S. N., Hunter, D. J., Mathieson, S., Mohamed, R. A., Li, L., Fung, N., Yue, A., & Ferreira, M. L. (2026) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.70254 · Cited by 1
Predicting long-term treatment with short-acting opioids: the role of general practice consultations and sociodemographic factors
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Influential
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“This knowledge gap is reflected in the most recent Canadian guidelines for opioid use for chronic non-cancer pain, which do not address acute admissions in this population [58].”
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Top resources and tools for physician management of chronic pain in the Canadian Armed Forces
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“The landscape surrounding the opioid crisis has changed drastically since the last publication on standardized mortality data in 2011, including changes to policy and guidelines around opioid prescription [7], treatment and retention in OAT [8].”
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Interventions for physician prescribers of opioids for chronic non-cancer pain: protocol for an overview of systematic reviews
Wennberg, E., Windle, S. B., Filion, K. B., Gore, G. C., Thombs, B. D., Kudrina, I., Paraskevopoulos, E., Martel, M. O., Kimmelman, J., Johnson, S., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-060964 · Cited by 1
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Opioid and Sedative Coprescription: Prescribing Patterns after an ICU Admission
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“One of the challenges in reviewing the literature is the substantial shift in practice guidelines for opioid therapy management that occurred in North America after 2016 [14,15].”
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Impact of Medical Cannabis on Recovery from Playing-Related Musculoskeletal Disorders in Musicians: An Observational Cohort Study
Cottrell, K., & Chong, J. P. (2024) · Healthcare · doi:10.3390/healthcare12131335 · Cited by 1
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Healthcare Provider Perspectives on Access to Healthcare for Chronic Low Back Pain Across Urban, Rural, and Remote Settings
Crockett, K., Lovo, S., Irvine, A., Trask, C., Oosman, S. N., McKinney, V., McDonald, T., Sari, N., Martínez-Rueda, R., Aiyer, H. P., et al. (2024) · Health Services Insights · doi:10.1177/11786329241265861 · Cited by 1
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“Since 2017, the last year of the study period, guidelines for the treatment of chronic non-cancer pain have recommended against opioid therapy, 21,30,31 pre-cipitating an expected decrease in the proportion of patients with chronic pain being prescribed fentanyl and other opioids.”
Background
La douleur chronique et les décès par intoxication aiguë accidentelle au Canada, 2016-2017
Venugopal, J., VanSteelandt, A., Yessick, L. R., Hamilton, K., & Leroux, J.-F. (2024) · Promotion de la santé et prévention des maladies chroniques au Canada · doi:10.24095/hpcdp.44.7/8.02f · Cited by 1
Analgesic medication considerations for chronic pain management post-bariatric surgery
Vij, S., Too, A., Tsang, V., & Kreutzwiser, D. (2024) · Expert Opinion on Drug Metabolism & Toxicology · doi:10.1080/17425255.2024.2398631 · Cited by 1
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Cross-National Analysis of Opioid Prescribing Patterns: Enhancements and Insights from the OralOpioids R Package in Canada and the United States
Banerjee, A., Nobleza, K. J., Nguyen, D. T., & Stricker, E. (2024) · BioMedInformatics · doi:10.3390/biomedinformatics4030112 · Cited by 1
“The package is informed by guidelines such as the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain [7] and the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, issued by the Centers for Disease Control and Prevention (CDC) [8].”
Applying Patient and Health Professional Preferences in Co-Designing a Digital Brief Intervention to Reduce the Risk of Prescription Opioid–Related Harm Among Patients With Chronic Noncancer Pain: Qualitative Analysis
Elphinston, R. A., Pager, S., Fatehi, F., Sterling, M. M., Brown, K., Gray, P. D., Hipper, L., Cahill, L., Ziadni, M. S., Worthy, P., et al. (2024) · JMIR Formative Research · doi:10.2196/57212 · Cited by 2
“In line with clinical guidelines that recommend multidisciplinary and behavioral treatment approaches as first line (eg, Dowell et al [40] and Busse et al [1]), patients reported that the inclusion of nonpharmacological pain management strategies (eg, relaxation, exercise, pleasant and valued…”
Co-Designing a Digital Brief Intervention to Reduce the Risk of Prescription Opioid–Related Harm Among People With Chronic Noncancer Pain: Qualitative Analysis of Patient Lived Experiences
Elphinston, R. A., Pager, S., Brown, K., Sterling, M. M., Fatehi, F., Gray, P. D., Hipper, L., Cahill, L., & Connor, J. P. (2025) · JMIR Formative Research · doi:10.2196/57208 · Cited by 1
“There is considerably less evidence on the effectiveness of opioid therapy for patients with chronic noncancer pain (CNCP) [2,3], and meta-analyses show modest CNCP relief [4].”
Patterns of opioid prescribing to opioid‐naive patients after surgical and emergency care: A population‐based cross‐sectional study using linked administrative databases in Nova Scotia (2017–2019)
Merdad, R. A., Asbridge, M., Campbell, S., Dutton, D. J., & Hayden, J. A. (2025) · Drug and Alcohol Review · doi:10.1111/dar.14029 · Cited by 1
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Sleep Quality in Chronic Pain Patients With and Without Strong Opioid Use: An Observational Study Using a Wearable Device
Ikemiya, H., Yamada, K., Chiba, S., Hamaoka, S., Hara, A., Yamaguchi, K., Iseki, M., & Kawagoe, I. (2025) · Neuropsychopharmacology Reports · doi:10.1002/npr2.70052
Cochrane in CORR®: Interventions for the Reduction of Prescribed Opioid Use in Chronic Non-cancer Pain
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The Promotion of Policy Changes Restricting Access to Codeine Medicines on Twitter: What do National Pain Organizations Say?
Elphinston, R. A., Requena, S. S., Angus, D. J., de Andrade, D., Freeman, C. R., & Day, M. A. (2019) · Journal of Pain · doi:10.1016/j.jpain.2019.12.001 · Cited by 2
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One Step Closer to Effective Pain Management Around the World?
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Wie lange dauert eine Langzeitanwendung?
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Exploring the use of extended release opioids at shortened dosing intervals in people with chronic pain and high risk medication or substance use
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A proof-of-concept study on the impact of a chronic pain and physical activity training workshop for exercise professionals
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“Chronic pain is a disease in its own right involving unpleasant sensory and emotional experiences unique to each individual and can be disabling without appropriate management [4–6], Individuals living with chronic pain experience limitations to their physical and mentalhealth, suchas reductions inphysical functioning…”
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Opioid Doctor Shopping: A Rare Phenomenon Among Patients with Chronic Non-Cancer Pain Followed in Tertiary Care Settings
Kaboré, J., Choinière, M., Dassieu, L., Lacasse, A., & Pagé, M. G. (2021) · Journal of Pain Research · doi:10.2147/jpr.s310580 · Cited by 1
“Opioids remain useful medications that should be prescribed for patients with chronic noncancer pain, without current or past substance use disorder and without other active psychiatric disorders, who have persistent problematic pain despite optimized nonopioid therapy, as suggested by the Guidelines.(6)”
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Impact of the COVID-19 Pandemic on Patterns of Prescription Opioid Use: A Retrospective Cohort Study of Adults Without a Cancer Diagnosis Initiating Opioids Using Administrative Claims Data
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Opioids, allies in musculoskeletal pain management
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Opioids in chronic pain – Primum non nocere
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Response to “Opioid warning label”
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Combined pharmacotherapy for chronic pain management
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Winner of the Ronald Melzack – Canadian Journal of Pain 2021 Paper of the Year Award / Récipiendaire du Prix Ronald Melzack Pour L’Annee 2021 Des Articles Parus Dans La Revue Canadienne de La Douleur
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The Use of Opioids in the Management of Chronic Pain
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Response to “Role of regulators in safe prescribing of opioids”
Furlan, A. D., & Williamson, O. D. (2017) · Canadian Medical Association Journal · doi:10.1503/cmaj.733208
Comment on a paper by Dupoiron et al. “A phase III randomized controlled study on the efficacy and improved bowel function of prolonged‐release ( PR ) oxycodone‐ naloxone (up to 160/80 mg daily) versus oxycodone PR ”
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Updates on chronic non-cancer pain management in face of the opioid crisis
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Authors: Busse, J. W., Craigie, S., Juurlink, D. N., Buckley, D. N., Wang, L., Couban, R. J., Agoritsas, T., Akl, E. A., Carrasco-Labra, A., Cooper, L., Cull, C., da Costa, B. R., Frank, J. W., Grant, G., Iorio, A., Persaud, N., Stern, S., Tugwell, P., Vandvik, P. O., & Guyatt, G. H.
Affiliations: University of Bern (CH)
ORCID: Busse, Jason W.
Juurlink, David N.
Buckley, D. Norman
Wang, Li
Couban, Rachel J.
Agoritsas, Thomas
Akl, Elie A.
Cooper, Lynn
Cull, Chris
Frank, Joseph W.
Iorio, Alfonso
Persaud, Navindra
Tugwell, Peter
Vandvik, Per Olav
Guyatt, Gordon H.
Venue: Canadian Medical Association Journal
Publisher: CMA Impact Inc.
Published: 2017-05-07
Volume: 189
Issue: 18
Pages: E659-E666
ISSN: 0820-3946 (ISSN-L)
1488-2329
DOI: 10.1503/cmaj.170363
PMC: PMC5422149
OpenAlex: W2612284626
Cited by: 707
References: 50
Citations by year: 2026: 37 · 2025: 58 · 2024: 71 · 2023: 59 · 2022: 82 · 2021: 107 · 2020: 105 · 2019: 86 · 2018: 67 · 2017: 29
FWCI: 73.70
Type: journal article
Language: en
Open access: gold
doi.org
Locations: Canadian Medical Association Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Archive ouverte UNIGE (University of Geneva) (publishedVersion, other-oa)
BORIS (University Library Bern) (submittedVersion)
Funders: U.S. Department of Veterans Affairs (IK2 HX001914)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Keywords: opioid therapy, chronic non-cancer pain, pain management, opioid prescribing
MeSH terms: Analgesics, Opioid, Dose-Response Relationship, Drug, Humans, Opioid-Related Disorders, Pain Measurement, Primary Health Care, Treatment Outcome, Drug Monitoring, Chronic Pain

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