Recommendations for Opioid Therapy and Chronic Non-Cancer Pain

The Canadian Chiropractic Association commends the newly released recommendations for opioid therapy and chronic non-cancer pain

TORONTO, May 9, 2017 /CNW/ – Canada’s new opioid prescribing guideline that was released yesterday is an important step forward in addressing Canada’s opioid crisis. The opioid crisis is not only a challenge of Canadians struggling with addiction, it is also a pain management crisis.

Opioids rapidly emerged as a first-line treatment for non-cancer pain. However, it is now clear the risks and harms of opioids usually far outweigh the benefits, including dependency and addiction. It is also troubling that many illicit opioid users were first introduced through prescription opioids.

“Low back pain and other musculoskeletal conditions are currently key drivers of non-cancer opioid prescribing,” says Alison Dantas, CEO of the Canadian Chiropractic Association, “That is why Canada’s chiropractors are already playing a leading role in responding to this crisis and are committed to being part of the solution.”

Chiropractors are one of five health professions that are signatories of Health Canada’s Joint Statement of Action and are working to develop solutions to improve the integration and access to non-pharmacological interprofessional pain management for Canadians.

In a press release from McMaster University, Dr. Jason Busse, principal investigator for developing the new guideline, associate professor at McMaster University, and a chiropractor, explains that “opioids are not first-line therapy for chronic non-cancer pain. There are important risks associated with opioids, such as unintentional overdose, and these risks increase with higher doses.”

The new guideline strongly recommends optimizing non-pharmacological therapy for patients with non-cancer pain such as low back pain.

“The key to reducing the number of new opioid users is to ensure access to evidence-based, non-opioid alternatives,” says Dr. Busse. Among the recommended non-pharmacological therapies for pain management is spinal manipulation, which is advised for the treatment of neck pain,1 headaches,1 and chronic back pain.2,3

“By working together to provide prompt access to clinical alternatives like chiropractic care, evidence suggests we can reduce reliance on opioids and achieve better outcomes for patients,” says Dantas.

The new and supporting guidelines are in line with the Canadian Chiropractic Association’s White Paper responding to Canada’s opioid crisis, A Better Approach to Pain Management.

The new recommendations on the use of opioids were published yesterday in the Canadian Medical Association Journal, officially titled The 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain. These recommendations were issued by The Michael G. DeGroote National Pain Centre at McMaster University and developed on behalf of Health Canada.


1. Nahin RL, Boineau R, Khalsa PS, Stussman BJ, Weber WJ. Evidence-based evaluation of complementary health approaches for pain management in the United States. Mayo Clinic Proc. 2016; 91(9): 1292-306. doi: 10.1016/j.mayocp.2016.06.007.

2. Chou R, Deyo R, Friedly J, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017; 166(7): 480-92. doi: 10.7326/M16-2458.

3. Chou R, Deyo R, Friedly J, et al. Noninvasive Treatments for Low Back Pain. AHRQ Comparative Effectiveness Reviews. 2016. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Feb. Report No.: 16-EHC004-EF.