Chronic noncancer pain management: Integration of a nurse-led program in primary care

Chronic noncancer pain management

Integration of a nurse-led program in primary care

Research article published in Canadian Family Physician March 2023, 69 (3) e52-e60


Problem addressed Chronic noncancer pain is often excessively managed with medications (most notably opioids) instead of nonpharmacologic options or multidisciplinary care—the gold standards.

Objective of program To offer an effective alternative to pharmacologic management of chronic noncancer pain in primary care.

Program description Patients 18 years of age or older with chronic noncancer pain were referred by family physicians or nurse practitioners in a family health team (outpatient, multidisciplinary clinic) in Ottawa, Ont. A registered nurse used the Pain Explanation and Treatment Diagram with patients, taught self-management skills (related to habits [smoking, consumption of alcohol, diet], exercise, sleep, ergonomics, and psychosocial factors), and referred patients to relevant resources.

Conclusion A nurse-led chronic pain program, initiated without extra funding, was successfully integrated into a primary care setting. Among the participating patients in the pilot project, outcomes related to pain intensity, pain interference with daily living, and opioid use were encouraging. This program could serve as a model for improving chronic noncancer pain management in primary care.

Chronic noncancer pain affects approximately 1 in 5 Canadians and leads to substantial social and economic costs.1-5 In 2019 it was estimated that 7.6 million Canadians were affected, with an estimated sum of direct and indirect costs related to chronic pain of $38.2 billion to $40.3 billion.1 By 2030 these numbers are expected to increase to 9 million people affected and $52 billion to $55 billion in associated costs.1 For chronic pain management, nonpharmacologic options and multidisciplinary care are recommended as gold standards.6-8 Self-management is central to such programs, as it empowers patients to adopt behaviour, strategies, and skills to improve their quality of life.9-11 In Canada most multidisciplinary clinics for chronic pain are located in hospitals, and access can be limited by long wait times.12 Family physicians or nurse practitioners are at the front lines of managing chronic pain, yet they often lack either the time or resources they need to access a multidisciplinary team with expertise in chronic pain.13-15

As an unfortunate result, care of patients with chronic pain often relies on prescription drugs, most notably opioids.16 Indeed, Canada has the second-highest rate of opioid prescribing per capita worldwide (after the United States) when measured as defined daily doses and the highest rate when reported as morphine equivalent (MEQ) dispensed,17,18 and opioid abuse and overdose have become serious public health concerns.19 While initiatives have aimed to address existing shortcomings in chronic pain management,17 there is still a clear need and opportunities to develop better approaches in primary care to serve these patients.


  • Metasebia Assefa, Research Project Coordinator, Children's Aid Society
  • Isabelle LeClerc, Bruyère Academic FHT
  • Dr. Elizabeth Muggah, Bruyère Academic FHT
  • Prof. Raywat Deonandan, University of Ottawa
  • Charles Godbout, Bruyère Research Institute
  • Prof. Hillel M. Finestone, University of Ottawa

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