This guideline is published in the Annals of Internal Medicine and recommends use of topical non-steroidal anti-inflammatory drugs (NSAIDs), then oral NSAIDs, then acetaminophen for acute musculoskeletal pain.  They recommend against the use of opioids, which were found to be no more effective, but more harmful, than NSAIDs.

This guideline was supported by systematic reviews led by the National Pain Centre on the management of acute pain from non–low back musculoskeletal injuries, and predictors of prolonged opioid use after initial prescription for acute musculoskeletal injuries.

These recommendations are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They should be used as an adjunct to inform clinical decision making.

Download the Guideline for the Evidence-Informed Primary Care Management of Low Back Pain here.

1. Opioid use disorder is often a chronic, relapsing condition associated with increased morbidity and death; however, with appropriate treatment and follow-up, individuals can reach sustained long-term remission.
2. This guideline strongly recommends opioid agonist treatment with buprenorphine–naloxone as the preferred first-line treatment when possible, because of buprenorphine’s multiple advantages, which include a superior safety profile in terms of overdose risk.
3. Withdrawal management alone is not recommended, because this approach has been associated with elevated risks (e.g., syringe sharing) and death from overdose in comparison to providing no treatment, and high rates of relapse when implemented without immediate transition to long-term evidence-based treatment.
4. This guideline supports using a stepped and integrated care approach, in which treatment intensity is continually adjusted to accommodate individual patient needs and circumstances over time, and recognizes that many individuals may benefit from the ability to move between treatments.

• Management of opioid use disorders: a national clinical practice guideline (CMAJ March 05, 2018 190 (9) E247- E257).

The target of this guideline is all Canadian healthcare professionals including primary care providers, medical specialists, and members of multidisciplinary teams who treat patients with fibromyalgia. It is also relevant to patients with fibromyalgia, who may find this guidance helpful for shared-care decision making.

• Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome in Adults (2012. Comprehensive, evidence-based and written by a panel of Canadian experts. Endorsed by the Canadian Pain Society and the Canadian Rheumatology Association)

These guidelines provide evidence-based guidelines for the diagnosis and management of endometriosis.

• Endometriosis: Diagnosis and Management (Journal of Obstetrcs and Gynaecology of Canada, Published July 2010)

The Special Interest Group of the Canadian Pain Society produced consensus-based guidelines for the pharmacological management of neuropathic pain. The society aimed to generate an additional guideline for other forms of neuropathic pain treatments.

• Evidence-based guideline for neuropathic pain interventional treatments: Spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks (Produced by the Canadian Pain Society Neuropathic Special Interest Group. Published in Pain Research & Management. 2012 May-June:; 17(3): 150-158)

The criteria used to determine the categorization of the recommendations (Do, Do Not Do, and Do Not Know) are defined at the end of the "Major Recommendations" field.

In addition, an explanation of the evidence source (i.e., types of evidence and corresponding "seed" guidelines) is also available. The Guideline Development Group (GDG) considered the balance of benefits and harms for the interventions listed in the Alberta Guideline. Italicized statements relating to harm are included in the recommendations, where appropriate. These statements were sourced from the recommendations or elsewhere in the "seed" guidelines, or were created by the GDG.

• Guideline for Management of Primary Headache in Adults (Published July 2012, Towards Optimized Practice, and Institute of Health Economics, Alberta, Canada)

The purpose of these guidelines is to clinicians make evidence-informed decisions about care of patients with non-specific low back pain.

• Guideline for the Evidence-Informed Primary Care Management of Low Back Pain (Updated November 2011)

• Pharmacological management of chronic neuropathic pain - Consensus statement and guidelines from the Canadian Pain Society(Pain Research & Management Vol 12 No 1 Spring 2007)

The Evidence-Based Recommendations for Medical Management of Chronic Non-Malignant Pain below is a guideline facilitated by the College of Physicians and Surgeons of Ontario (CPSO). It is posted on the National Pain Centre website for historical reference. This Guideline was published in November 2000 and functioned as the opioid guideline for that time. The accompanying document Reference Guide for Clinicians for the Medical Management of Chronic Non-Malignant Pain contains information for clinicians extracted from the 2000 guideline. In May 2010 the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain became the current source for information on opioids. The 2010 Guideline will be updated in five years.

• Evidence-Based Recommendations for Medical Management of Chronic Non-Malignant Pain (CPSO 2000) (Opioid chapter replaced by Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain in 2010)
• Reference Guide for Clinicians for the Medical Management of Chronic Non-Malignant Pain (CPSO 2000) (Opioid chapter replaced by Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain in 2010)