TY - JOUR T1 - PEER simplified chronic pain guideline JF - Canadian Family Physician JO - Can Fam Physician SP - 179 LP - 190 DO - 10.46747/cfp.6803179 VL - 68 IS - 3 AU - Christina S. Korownyk AU - Lori Montgomery AU - Jennifer Young AU - Simon Moore AU - Alexander G. Singer AU - Peter MacDougall AU - Sean Darling AU - Kira Ellis AU - Jacqueline Myers AU - Candice Rochford AU - Marie-Christine Taillefer AU - G. Michael Allan AU - Danielle Perry AU - Samantha S. Moe AU - Joey Ton AU - Michael R. Kolber AU - Jessica Kirkwood AU - Betsy Thomas AU - Scott Garrison AU - James P. McCormack AU - Jamison Falk AU - Nicolas Dugré AU - Logan Sept AU - Ricky D. Turgeon AU - Allison Paige AU - Jen Potter AU - Tony Nickonchuk AU - Anthony D. Train AU - Justin Weresch AU - Karenn Chan AU - Adrienne J. Lindblad Y1 - 2022/03/01 UR - http://www.cfp.ca/content/68/3/179.abstract N2 - Objective To develop a clinical practice guideline to support the management of chronic pain, including low back, osteoarthritic, and neuropathic pain in primary care.Methods The guideline was developed with an emphasis on best available evidence and shared decision-making principles. Ten health professionals (4 generalist family physicians, 1 pain management–focused family physician, 1 anesthesiologist, 1 physical therapist, 1 pharmacist, 1 nurse practitioner, and 1 psychologist), a patient representative, and a nonvoting pharmacist and guideline methodologist comprised the Guideline Committee. Member selection was based on profession, practice setting, and lack of financial conflicts of interest. The guideline process was iterative in identification of key questions, evidence review, and development of guideline recommendations. Three systematic reviews, including a total of 285 randomized controlled trials, were completed. Randomized controlled trials were included only if they reported a responder analysis (eg, how many patients achieved a 30% or greater reduction in pain). The committee directed an Evidence Team (composed of evidence experts) to address an additional 11 complementary questions. Key recommendations were derived through committee consensus. The guideline and shared decision-making tools underwent extensive review by clinicians and patients before publication.Recommendations Physical activity is recommended as the foundation for managing osteoarthritis and chronic low back pain; evidence of benefit is unclear for neuropathic pain. Cognitive-behavioural therapy or mindfulness-based stress reduction are also suggested as options for managing chronic pain. Treatments for which there is clear, unclear, or no benefit are outlined for each condition. Treatments for which harms likely outweigh benefits for all or most conditions studied include opioids and cannabinoids.Conclusion This guideline for the management of chronic pain, including osteoarthritis, low back pain, and neuropathic pain, highlights best available evidence including both benefits and harms for a number of treatment interventions. A strong recommendation for exercise as the primary treatment for chronic osteoarthritic and low back pain is made based on demonstrated long-term evidence of benefit. This information is intended to assist with, not dictate, shared decision making with patients. ER -