• 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.
• Professor in the Department of Family Medicine at the University of Alberta in Edmonton. cpoag@ualberta.ca.
• Can Fam Physician. 2022 Mar 1; 68 (3): 179190179-190.

ObjectiveTo develop a clinical practice guideline to support the management of chronic pain, including low back, osteoarthritic, and neuropathic pain in primary care.MethodsThe 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.RecommendationsPhysical 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.ConclusionThis 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.Copyright© 2022 the College of Family Physicians of Canada.

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