Starting a trial of opioids

The role of opioids in chronic pain

In chronic pain the 2017 opioid guidelines suggest trying non opioid medications such as acetaminophen and anti inflammatory. If these are not helpful a trial of opioids can be initiated with clear functional goals as a target for determining the effectivnes of the opioid. Doses should not be increased to more than 50mg per day of Morphine Equivalent Dose (MED). If functional goals are not met, opioids should be weaned off. Each of the risks and benefits should be weighed before considering trying opioids.

Opioids are not helpful in certain conditions

  • Headaches
  • IBS
  • Pelvic pain
  • TMJ pain
  • Atypical Facial Pain
  • Lyme Disease
  • Whiplash
  • Repetitive strain injuries.

Did you know?

Research shows patients receiving long term opioid therapy have worse pain and function than patients with similar pain who are not taking opioids.

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Other options for pain management

Talk to your health care provider about ways to manage your pain that don’t involve prescription opioids.

These options may actually work better and have fewer risks and side effects.

Options that may help include:

  • Physical therapy and exercise
  • Cognitive behavioral therapy and mindfulness based stress reduction.
  • Acetaminophen (Tylenol®)
  • Anti-inflammatories (Advil®, Aleeve®, Celebrex®)
  • Medications used for depression or seizures may also be helpful for nerve pain

Please visit the TAPMI referral page to see if you could benefit from a referral to a multi-disciplinary program.

Get Referred

Starting Opioids

Like any medications, the use of opioids should be considered as a trial. If they do not significantly improve your pain and/or function, or you experience medical complications, or side effects, opioids should then be tapered and discontinued.

  1. When you are first starting on an opioid, a weaker opioid such as codeine, tramadol, or transdermal buprenorphine may initially be considered.
  2. You should follow up with your healthcare provider every 1-4 weeks when you first start an opioid to monitor for benefits and risks.
  3. Your primary care provider will most likely ask you to sign an opioid agreement and you may be asked for urine drug screens as a way to monitor your safety .
  4. If there is no meaningful improvement in function, such as returning to work/school or daily activities, opioids are not the right medication for you and you may want to consider tapering or weaning.

Resources & Links

Best Advice for People Taking Opioid Meds
Dr. Mike Evans YouTube Channel 

Opioid Resource Hub
Centre for Addiction & Mental Health

Opioid Pain Medicines Info for Patients & Families
Institute for Safe Medication Practices Canada 

76 Grenville St. Toronto, ON M5S 1B2 Canada

TAPMI Hub Clinic

Phone: 416-323-6269 Office Fax: 416-323-2666 Hours: 8:00 a.m. – 4:00 p.m. Monday – Friday

Administration

Dr. Tania Di Renna, Medical Director Laura Pus, Administrative Director