Attitudes toward the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: A qualitative study

Yaping Chang, MSc; Kan Lun Zhu; Ivan D. Florez, MD, MSc; Sung Min Cho, BHSc; Nasim Zamir, HBSc; Augustin Toma, BESc; Reza Donald Mirza, MD; Gordon H. Guyatt, MD, MSc; Norman Buckley, MD; Jason W. Busse, DC, PhD

doi:10.5055/jom.2016.0357

Authors

Yaping Chang, MSc
Kan Lun Zhu
Ivan D. Florez, MD, MSc
Sung Min Cho, BHSc
Nasim Zamir, HBSc
Augustin Toma, BESc
Reza Donald Mirza, MD
Gordon H. Guyatt, MD, MSc
Norman Buckley, MD
Jason W. Busse, DC, PhD

DOI:

https://doi.org/10.5055/jom.2016.0357

Keywords:

clinical guideline, opioids, chronic pain, Canadian attitudes, usage barrier

Abstract

Background: Chronic noncancer pain (CNCP) refers to all pain disorders, not due to cancer, that persist for ≥3 months. The point prevalence of CNCP in the general population of Western countries is between 19 and 33 percent. Opioids are commonly prescribed for CNCP and are associated with both benefits and harms. The Canadian Guideline for Safe and Effective Use of Opioids for CNCP was published in 2010 to provide guidance for optimal opioid prescribing in patients with CNCP.

Objectives: To investigate the attitudes toward, and use of, the Canadian Opioids Guideline among pain physicians.

Design: A qualitative study using one-on-one, semistructured interviews with 12 pain physicians in Ontario, Canada, and thematic analysis of verbatim transcripts.

Results: Major themes that emerged from interviews included: (1) generally positive attitudes toward the 2010 Canadian Opioids Guideline, but limited use—half (six of 12) reported they did not use the guideline in practice; (2) strongly contrasting views regarding the 200 mg/d morphine equivalent watchful dose; (3) recognition of gaps in the guideline, especially recommendations for urine drug screening and pain severity-specific therapy; (4) the guideline is excessively long and the format suboptimal; and (5) improved dissemination and education are needed to enhance guideline uptake.

Conclusions: Despite its merits, the Canadian Opioids Guideline suffers from information gaps and from limited uptake, at least in part due to suboptimal format and suboptimal dissemination.

Author Biographies

Yaping Chang, MSc

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Kan Lun Zhu

Student, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Ivan D. Florez, MD, MSc

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, University of Antioquia, Medellin, Colombia

Sung Min Cho, BHSc

Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Nasim Zamir, HBSc

Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Augustin Toma, BESc

Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Reza Donald Mirza, MD

Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada.

Gordon H. Guyatt, MD, MSc

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Norman Buckley, MD

Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada

Jason W. Busse, DC, PhD

Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada

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