Chronic pain guideline for primary care

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Goodfellow Gems

Chronic pain guideline for primary care

This is the work of a Canadian panel that filtered 74,000 papers to get a summary for chronic pain management of osteoarthritis, low back pain, and neuropathic pain.1

Figure 1 in the guideline provides a simple summary (the authors suggest this is how guidelines should be reported):

  • Placebo is fairly effective 29% to 40%.
  • Physical activity is essential for OA and back pain.
  • For OA (NZ available drugs) - steroid injections, oral and topical NSAIDs.
  • Glucosamine and chondroitin are of uncertain benefit as the publicly funded trials found no benefit while the industry-sponsored ones did show benefit.
  • For low back pain - spinal manipulation, oral NSAIDs, and TCAs.
  • For neuropathic pain - gabapentinoids and rubefacients, e.g. capsaicin.  

The authors felt cannabinoids and opiates showed that harms exceeded benefits.

Reference:

  1. PEER simplified chronic pain guideline CFP (2022)  View

Gems are chosen by the Goodfellow director Dr Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.



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