Chronic pain remains one of the leading reasons patients consult with a primary health care provider. Most common are lower back pain, or neck/shoulder pain. In its 2016 Population Snapshot report, the New Brunswick Health Council indicates that the prevalence of chronic pain in New Brunswick was 14% at the time of the report.
Pharmacological approaches including opioids for the treatment of pain continues to be recommended in certain situations such as injuries, post surgery, some cases of chronic pain, cancer, and palliative care. However, there is increasing support for exploring non-opioid options for treating pain, particularly in the presence of acute and subacute pain to reduce the risk of opioid dependency, or opioid use disorders. In lieu of, or as an adjunct to opioids, non-pharmacological therapies such as physical therapy and osteopathy as part of a multi modal approach to treating pain is fast becoming a recommended approach. The Canadian Guidelines for Opioids for Chronic Non-Cancer Pain (McMaster National Pain Center) recommend optimizing non- opioid pharmacotherapy and non-pharmacological therapy as first line options.
Multi disciplinary treatment approaches are known for leading to significant improvements from baseline in pain and function or disability. Chronic pain can take a toll on individuals. Mental health and substance use issues can be associated to chronic pain and therefore highlight the importance of including psychology or other psycho social services in the multi disciplinary approach.
There is increasing awareness of the risks of opioids and evidence consistently supports the optimization of non-opioid pharmacotherapy and non-pharmacological options as first line options for treating pain. The following clinical tools and resources provide information and guidance on different options that can be used instead of, or as adjuncts to opioid prescribing in the context of pain management.
This section provides links to valuable sources of information relating to non-opioid and non-pharmacological options for pain management along with evidence to support them. Ranging from manual therapies to mindfulness these options can further enhance treatment outcomes.
|Non-Opioid Options for Managing Adult Chronic Pain (CADTH, Sept 2020)||To help support decisions about managing pain, CADTH has been reviewing the evidence on different treatment options for various types of pain through our Rapid Response Service. Here, you’ll find the highlights of many of these evidence reviews — all in one place. For more information about CADTH’s work related to pain management or opioids, please visit cadth.ca/pain and cadth.ca/opioids|
|Non-Drug Ways to Manage Chronic Pain (CADTH, Sept 2020) – Online Collection for Clinicians & Patients Specific Clinician Tools: Non-Pharmacological Methods for Managing Chronic Pain: Physical Methods Non-Pharmacological Methods for Managing Chronic Pain: Psychological Methods Non-Pharmacological Methods for Managing Chronic Pain: Preventive Methods||CADTH completed a series of evidence reviews to appraise and summarize the research on the effectiveness of non-drug methods for the treatment of chronic, non-cancer pain. These reviews were used to develop a series of printable patient handouts and clinician evidence summaries, which can be found at cadth.ca/chronic pain These summaries for clinicians coincide with the handouts for people living with chronic pain. They include “practical considerations,” which are useful tips and strategies for recommending the use of each non-drug method to patients.|
|Chronic Pain Prescription Pad: Thinking Outside the Medicine Cabinet – Non-Drug Ways to Manage Chronic Pain||Based on a series of evidence reviews, CADTH developed a series of printable and fillable handouts encouraging non-drug methods either on their own, or in combination with medication.|
|Acute Pain Management: Non-Pharmacological Interventions (CADTH, Sept 2020)||In the last few years, CADTH has been asked to review, through our Rapid Response Service, the clinical effectiveness evidence and the recommendations from evidence-based guidelines for treating various acute pain conditions with non-pharmacological interventions. Here, you’ll find the evidence highlights related to those evidence reviews. For more information about the CADTH work and evidence on pain management, please visit cadth.ca/pain.|
|CADTH Medical Cannabis Evidence Bundle||CADTH’s evidence bundle on medical cannabis provides evidence for the medical use of cannabis specific conditions and populations; pain treatment; safety, use with other medications misuse/abuse and harms; along with additional helpful tools and resources.|
|Multidisciplinary Treatment Programs for Patients with Acute or Subacute Pain: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines (CADTH Rapid Response Report, Summary with Critical Appraisal, May 2019)||This 2019 report reviews the clinical effectiveness and cost-effectiveness of multidisciplinary treatment programs for patients with acute or subacute pain in outpatient settings. Additionally, it reviews the evidence-based guidelines regarding multidisciplinary treatment programs for patients with acute or subacute pain in outpatient settings.|
|CADTH Mental Health evidence bundle||The CADTH mental health evidence bundles provides an up to date collection of products in the mental health area ranging from short reports to in-depth systemic reviews and various tools and resources intended to help translate mental health research evidence into action.|
|Non-Pharmacological Interventions for Chronic Non-Cancer Pain: The Science of Mindfulness (Oct 2019) – recording available online||This CADTH webinar provides information on the current evidence on mindfulness and the science behind it for chronic non-cancer pain. The target audience for tis presentation is physicians, nurses, allied health professionals, researchers, educators, administrators and health sciences students.|
|Non-Pharmacological Interventions for Chronic Non-Cancer Pain: Acupuncture (CADTH, March 2020)||This CADTH webinar provides information on the current evidence on acupuncture for chronic non-cancer pain. The target audience for this presentation is physicians, nurses, allied health professionals, researchers, educators, administrators, and health sciences students.|
|Cognitive Behavioural Therapy for Chronic Non-Cancer Pain: A Review of Clinical Effectiveness (CADTH, Sept 2019)||Provides information relating to evidence and clinical effectiveness supporting Cognitive Behavioral Therapy for chronic non-cancer pain.|
|Evidence-to-Action: Accessing Mental Health Support Outside of a Therapist’s Office: iCBT for Major Depression and Anxiety Disorders (CADTH, Nov 2019||This webinar provides information on Internet-delivered cognitive behavioural therapy (iCBT). This is a treatment options for people living with depression or anxiety disorders. This webinar provides the opportunity to increase awareness around existing iCBT work in Canada and facilitates a conversation between various stakeholders across the country.|