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Research ArticleClinical Practice Guidelines

PEER simplified chronic pain guideline

Management of chronic low back, osteoarthritic, and neuropathic pain in primary care

Christina S. Korownyk, Lori Montgomery, Jennifer Young, Simon Moore, Alexander G. Singer, Peter MacDougall, Sean Darling, Kira Ellis, Jacqueline Myers, Candice Rochford, Marie-Christine Taillefer, G. Michael Allan, Danielle Perry, Samantha S. Moe, Joey Ton, Michael R. Kolber, Jessica Kirkwood, Betsy Thomas, Scott Garrison, James P. McCormack, Jamison Falk, Nicolas Dugré, Logan Sept, Ricky D. Turgeon, Allison Paige, Jen Potter, Tony Nickonchuk, Anthony D. Train, Justin Weresch, Karenn Chan and Adrienne J. Lindblad
Canadian Family Physician March 2022; 68 (3) 179-190; DOI: https://doi.org/10.46747/cfp.6803179
Christina S. Korownyk
Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
MD CCFP
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  • For correspondence: cpoag@ualberta.ca
Lori Montgomery
Family physician with a focused practice in chronic pain in Calgary, Alta.
MD CCFP FCFP
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Jennifer Young
Family physician practising in Collingwood, Ont.
MD CCFP(EM) FCFP
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Simon Moore
Clinical Assistant Professor in the Department of Family Practice at the University of British Columbia in Vancouver.
MD CCFP
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Alexander G. Singer
Associate Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg.
MBBCh BAO CCFP
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Peter MacDougall
Professor in the Department of Anesthesia Pain Management and Perioperative Medicine at Dalhousie University in Halifax, NS.
PhD MD FRCPC
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Sean Darling
Adjunct Assistant Professor in the School of Public Administration at the University of Victoria in British Columbia.
PhD
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Kira Ellis
Physiotherapist and Senior Consultant for the Alberta Health Services Rehabilitation Advice Line.
BScPT
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Jacqueline Myers
Clinical pharmacist for the Saskatchewan Health Authority, Regina Area.
BSP
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Candice Rochford
Nurse practitioner in Charlottetown, PEI.
NP
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Marie-Christine Taillefer
Clinical psychologist in the pain clinic of the Centre hospitalier de l’Université de Montréal in Quebec.
PhD
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G. Michael Allan
Director of Programs and Practice Support at the College of Family Physicians of Canada (CFPC).
MD CCFP
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Danielle Perry
Clinical Evidence Expert for the CFPC and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta.
MSc RN
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Samantha S. Moe
Clinical Evidence Experts for the CFPC.
ACPR PharmD
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Joey Ton
Clinical Evidence Experts for the CFPC.
PharmD
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Michael R. Kolber
Professor in the Department of Family Medicine at the University of Alberta.
MD MSc CCFP
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Jessica Kirkwood
Family physician and Assistant Professor in the Department of Family Medicine at the University of Alberta.
MD CCFP(AM)
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Betsy Thomas
Clinical Evidence Expert for the CFPC and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta.
BScPharm
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Scott Garrison
Professor in the Department of Family Medicine at the University of Alberta.
MD CCFP PhD
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James P. McCormack
Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia.
PharmD
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Jamison Falk
Associate Professor in the College of Pharmacy at the University of Manitoba.
PharmD
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Nicolas Dugré
Pharmacist at the CIUSSS du Nord-de-l’Île-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montreal.
PharmD MSc
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Logan Sept
Medical student at the University of Alberta.
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Ricky D. Turgeon
Assistant Professor and Clinical Pharmacy Specialist at the University of British Columbia.
PharmD ACPR
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Allison Paige
Assistant Professor in the Department of Family Medicine at the University of Manitoba.
MD CCFP
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Jen Potter
Assistant Professor in the Department of Family Medicine at the University of Manitoba.
MD CCFP
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Tony Nickonchuk
Pharmacist with Alberta Health Services Provincial Drug Utilization and Stewardship.
BScPharm
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Anthony D. Train
Assistant Professor in the Department of Family Medicine at Queen’s University in Kingston, Ont.
MBChB MSc CCFP
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Justin Weresch
Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
MD CCFP
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Karenn Chan
Associate Professor and a care of the elderly physician at the University of Alberta.
MD CCFP(COE)
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Adrienne J. Lindblad
Clinical Evidence Expert Lead for the CFPC and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.
ACPR PharmD
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  • Article
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    PEER simplified chronic pain guideline: Summary. Treatment interventions for discussion with patients

Tables

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    Table 1.

    GRADE quality-of-evidence table for all recommendations

    TOPICFINAL GRADE RATING
    Exercise for osteoarthritis10Low
    Exercise for chronic low back pain11Moderate
    TCAs for low back painModerate
    Topical agents (non-nitrate)Moderate
    Topical agents (nitrates)Low
    Psychological treatmentsLow
    Best exercise typeLow
    Tapering opioidsVery low
    CannabinoidsVery low
    Assisting to exerciseVery low
    Drug combinationsVery low
    Weight loss for osteoarthritisLow
    Intra-articular steroids for osteoarthritis10Very low
    SNRIs for osteoarthritis10Moderate
    Oral NSAIDs for osteoarthritis10Moderate
    Topical NSAIDs for osteoarthritis10Low
    Glucosamine for osteoarthritis10Very low
    Chondroitin for osteoarthritis10Moderate
    Viscosupplementation for osteoarthritis10Very low
    Opioids for osteoarthritis10Very low
    Acetaminophen for osteoarthritis10Low
    Oral NSAIDs for back pain11Moderate
    SNRIs for back pain11Moderate
    Spinal manipulation for back pain11Low
    Acupuncture for back pain11Very low
    Rubefacients for back pain11Low
    Corticosteroid injections for back pain11Very low
    Opioids for low back pain11Very low
    Anticonvulsants for neuropathic pain12Moderate
    SNRIs for neuropathic pain12Moderate
    Rubefacients for neuropathic pain12Low
    TCAs for neuropathic pain12Very low
    Opioids for neuropathic pain12Low
    • GRADE—Grading of Recommendations Assessment, Development and Evaluation; NSAID—nonsteroidal anti-inflammatory drug; SNRI—serotonin-norepinephrine reuptake inhibitor; TCA—tricyclic antidepressant.

Additional Files

  • Figures
  • Tables
  • CFPlus Additional Material

    • Figure_1_Simplified_Chronic_Pain_Guideline.pdf
    • Appendix_1_Guideline_and_Systematic_Review.pdf
    • Appendix_2_Patient_Handout.pdf
    • Appendix_3_Peer_Review_Responses.pdf
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Canadian Family Physician: 68 (3)
Canadian Family Physician
Vol. 68, Issue 3
1 Mar 2022
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PEER simplified chronic pain guideline
Christina S. Korownyk, Lori Montgomery, Jennifer Young, Simon Moore, Alexander G. Singer, Peter MacDougall, Sean Darling, Kira Ellis, Jacqueline Myers, Candice Rochford, Marie-Christine Taillefer, G. Michael Allan, Danielle Perry, Samantha S. Moe, Joey Ton, Michael R. Kolber, Jessica Kirkwood, Betsy Thomas, Scott Garrison, James P. McCormack, Jamison Falk, Nicolas Dugré, Logan Sept, Ricky D. Turgeon, Allison Paige, Jen Potter, Tony Nickonchuk, Anthony D. Train, Justin Weresch, Karenn Chan, Adrienne J. Lindblad
Canadian Family Physician Mar 2022, 68 (3) 179-190; DOI: 10.46747/cfp.6803179

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PEER simplified chronic pain guideline
Christina S. Korownyk, Lori Montgomery, Jennifer Young, Simon Moore, Alexander G. Singer, Peter MacDougall, Sean Darling, Kira Ellis, Jacqueline Myers, Candice Rochford, Marie-Christine Taillefer, G. Michael Allan, Danielle Perry, Samantha S. Moe, Joey Ton, Michael R. Kolber, Jessica Kirkwood, Betsy Thomas, Scott Garrison, James P. McCormack, Jamison Falk, Nicolas Dugré, Logan Sept, Ricky D. Turgeon, Allison Paige, Jen Potter, Tony Nickonchuk, Anthony D. Train, Justin Weresch, Karenn Chan, Adrienne J. Lindblad
Canadian Family Physician Mar 2022, 68 (3) 179-190; DOI: 10.46747/cfp.6803179
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