Lignes directrices canadiennes relatives à l’utilisation des opioïdes pour le traitement de la douleur chronique non cancéreuse, édition 2017

Main Editor Jason Busse Associate Professor, Department of Anesthesia, Associate Professor, Department of Health Research Methods, Evidence and Impact McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, Ontario, Canada, L8S 4K1 bussejw@mcmaster.ca
Language fr
Last Update Sep 28, 2017
Published Date Sep 28, 2017
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Disclaimer

Ces lignes directrices sont issues d’une étude réalisée à l’initiative de chercheurs, subventionnée grâce à des bourses des Instituts de recherche en santé du Canada et de Santé Canada. Les bailleurs de fonds n’ont joué aucun rôle dans la conception ou la réalisation de l’étude; la collecte, l’analyse et l’interprétation des données; ou la préparation, la révision ou l’approbation des lignes directrices. Le personnel de Santé Canada a émis des commentaires non contraignants au cours de l’étude. Les décisions finales concernant le protocole et les questions soulevées pendant le processus de mise au point des lignes directrices étaient du ressort du Comité directeur.

Sponsors Les fonds nécessaires à ce guide de recommandations sont fournis par Santé Canada et une subvention des Instituts de recherche en santé du Canada.
Abstract

PICOS
PICO 4.0
P: Patients with chronic non-cancer pain, without current or past substance use disorder and without other current serious psychiatric disorders, whose therapy is optimized with non-opioids with persistent problematic pain
I: Trial of opioids.
C: Continue established therapy without opioids.
O:

PICO 4.0
P: Patients with chronic non-cancer pain considering first line therapy for pain
I: Trial of opioids.
C: Optimization of therapy with NSAIDs.
O:

PICO 4.0
P: Patients with chronic non-cancer pain considering first line therapy for pain
I: Trial of opioids.
C: Optimization of therapy with anticonvulsants.
O:

PICO 4.0
P: Patients with chronic non-cancer pain considering first line therapy for pain
I: Trial of opioids.
C: Optimization of therapy with mexiletine.
O:

PICO 4.0
P: Patients with chronic non-cancer pain considering first line therapy for pain
I: Trial of opioids.
C: Optimization of therapy with nabilone.
O:

PICO 4.0
P: Patients with chronic non-cancer pain considering first line therapy for pain
I: Trial of opioids.
C: Optimization of therapy with tricyclic antidepressants.
O:

PICO 4.0
P: Patients with chronic non-cancer pain with an active substance use disorder whose non-opioid therapy has been optimized
I: Trial of opioids
C: Continue established therapy without opioids
O:

PICO 4.0
P: Patients with chronic non-cancer pain with a history of substance use disorder, whose non-opioid therapy has been optimized, who still experience persistent problematic pain
I: Trial of opioids
C: Continuing established therapy without opioids
O:

PICO 4.0
P: Patients with chronic noncancer pain with an active psychiatric disorder whose non-opioid therapy has been optimized, and who still experience persistent problematic pain
I: Trial of opioids
C: Continue established therapy without opioids
O:

PICO 4.0
P: Patients with chronic noncancer pain beginning opioid therapy
I: Limit opioid dose to a particular maximum dose
C: No maximum opioid dose
O:

PICO 5.0
P: Patients who want to taper opioids who are above the threshold dose
I: Multidisciplinary Program
C: No Multidisciplinary Program
O:

PICO 5.0
P: Patients with chronic non-cancer pain on opioids with persistent problematic pain
I: Tapering of opioid
C: Keeping the dose of opioid the same
O:

PICO 5.0
P: Patients with chronic non-cancer pain with persistent problematic pain and/or problematic side effects
I: Rotation to other opioids
C: No change in opioid therapy
O:

PICO 7.0
P: Patients with chronic non-cancer pain on long-term opioid therapy with clinical and biochemical evidence of hypogonadism.
I: Hormone replacement therapy while maintaining current opioid dose.
C: Taper opioids to treat hypogonadism.
O:

PICO 7.0
P: Patients with chronic non-cancer pain prior to starting long term opioid therapy
I: Urine drug screening for baseline substance use.
C: No urine drug screening for baseline substance use.
O:

PICO 7.0
P: Patients with chronic non-cancer pain prior to starting long-term opioid therapy
I: Formal structured treatment agreements.
C: No formal structured treatment agreement.
O:

PICO 7.0
P: Patients with chronic non-cancer pain prior to starting long-term opioid therapy.
I: Provide take-home naloxone along with opioid prescription.
C: Do not provide take-home naloxone along with opioid prescription.
O:

PICO 7.0
P: Patients with chronic non-cancer pain prior to starting long-term opioid therapy
I: Controlled release opioids
C: Immediate release opioids
O: