Back Pain
- Understanding Low Back Pain (video) by Dr.Mike Evans
- Back Phyiscal Exam
- Low Back Pain Guideline & Supporting Resources – IHE
The 3-Minute Primary Care Low Back Examination
- Part 1: Introduces the examination process and outlines the major steps and key considerations (VIDEO)
- Part 2: Walks viewers through the examination in detail (VIDEO)
- Part 3: Reviews the examination, highlighting key elements
- Video series from IHE – physical exam(VIDEO)
Back Tools/Guidelines:
- CORE Back Tool. Center for Effective Practice.
- STarT Back tool
- Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Qaseem et al. (2017)
Management:
- Low Back Pain & Lumbar Spinal Stenosis Practical Evaluation & Management Tips
- Yoga treatment for chronic non-specific low back pain
- A Partnership to Help Clinicians Support their Patients
- Management of persistent pain in the older patient: a clinical review. Makris UE, Abrams RC, Gurland B, Reid MC. JAMA. 2014 Aug 27;312(8):825-36. doi: 10.1001/jama.2014.9405. PMID: 25157726; PMCID: PMC4372897: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372897/
Management: Non-Pharmacological Therapies
- “Z Sit” for back pain relief
- Back belt use for prevention of occupational low back pain: a systematic review. Ammendolia C, Kerr MS, Bombardier C. J Manipulative Physiol Ther. 2005 Feb;28(2):128-34. doi: 10.1016/j.jmpt.2005.01.009. PMID: 15800513. https://www.jmptonline.org/article/S0161-4754(05)00010-2/fulltext
Educational Resources and Tools – For Patients
Treating low back pain (imaging tests & bed rest) – Choose Wisely Canada
Spinal Stenosis
- Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative. JAMA Netw Open. 2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2720073
- “Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial.” Ammendolia, Carlo, et al. Archives of physical medicine and rehabilitation 99.12 (2018): 2408-2419. https://www.sciencedirect.com/science/article/pii/S0003999318303629
- Carlo’s Spinal Stenosis program’s website
Cannabis
- Authorizing Dried Cannabis for Chronic Pain or Anxiety: Preliminary Guidance. College of Family Physicians of Canada (2014)
- Cannabis – tools, resources and articles. Ontario College of Family Physicians
- Cannabis legislation fails to protect Canada’s youth – Kelshall (2017)
- Cannabis pain relief without the ‘high’
- Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids. Government of Canada (2018)
- Marijuana for Medical Purposes
- Medical Cannabinoids: Guideline Summary
- Medical Document Authorizing the use of Cannabis for Medical Purposes under the Access to Cannabis for Medical Purposes Regulations – Government of Canada
- Simplified guideline for prescribing medical cannabinoids in primary care. Allan et al. (2018)
- The Cannabis and Canada’s children and youth
Community Resources
- Crisis Services
- First Nations Health Authority (FNHA)
- Glycemic Index Foods Advanced Search
- Health Services Information for Ontarians
- Low FODMAP diet for Irritable Bowel Syndrome
- Mental Health Resources
- Motivational Interviewing (MI) — Websites of Interest
- Food Guide Canada – Resources for patients
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Online supports for people with cancer
- The John Howard Society of Canada (works with people who have conflicts with the law)
- Unlock food (formally Eat Right Ontario) (provides access to dieticians)
Headaches
- Guideline for Primary Care Management of Headache in Adults
- Guideline for Primary Care Management of Headaches – IHE
- Headache
- Imaging Tests for headaches – Choose Wisely Canada
- Choosing Wisely – Headaches
Migraines
- How to investigate and treat: migraine in patients with temporomandibular disorders
- [App] Migraine Tracking
- My Chronic Migraine
- Treatment of comorbid migraine and temporomandibular disorders
- Unitary hypothesis for multiple triggers of the pain and strain of migraine
Conditions Specific Toolkits and Guidelines
- [Head and Neck Pain] CORE Neck Tool and Headache Navigator. Center for Effective Practice
- Guideline for Primary Care Management of Headache in Adults
- Core Headache Tool & Headache Navigator
- Migraine Disability Assessment Tool
- Quick Reference: Primary Care Management of Headache in Adults
Patient Resources and Tools
Neuropathic Pain
- Neuropathic Pain Physical Exam by Dr. Pam Squire (Video)
- Exercise therapy normalizes BDNF upregulation and glial hyperactivity in a mouse model of neuropathic pain
- Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society (CPS). Moulin et al. (2014)
Assessment (Condition specific)
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[Neuropathic Pain] Neuropathic Pain Diagnostic Questionnaire (DN4)
Fibromyalgia
- [Fibromyalgia]Novel pharmaceutical options for treating fibromyalgia – Gerardi et al
- [Fibromyalgia] Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome in Adults. Fitzcharles et al. (2012)
- The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms
- FibroGuide
Myofascial Pain
- Myofascial Pain
- [Trigger Points] The Trigger Point & Referred Pain Guide
- Travell & Simons’ myofascial pain and dysfunction, 3rd edition (preview): https://books.google.ca/books?id=qYxjDwAAQBAJ&lpg=PP1&pg=PP1#v=onepage&q&f=false
- A review of skeletal muscle relaxants for pain management. Fudin, J., and M. Raouf. Pract Pain Manag 16.5 (2016): 1-15. https://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/review-skeletal-muscle-relaxants-pain-management
Patient Education Resources – Myofascial Pain
- http://bit.ly/Exercises_Myofascial_Neck
- http://bit.ly/Exercise_myofascial_LBP
- http://bit.ly/DrFurlan_Myofascial
- UHN Patient education brochure of myofascial pain: https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Myofascial_Pain_Syndrome.pdf
Central Sensitization Syndrome
Chronic Pain as a Symptom or a Disease
- the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)
- Paid version
- Tame the Beast, patient resource website from Lorimer Moseley
- Sensory exams demonstration by Dr. Pam Squire
Non-Pharmacological Therapies
Goals and Goal Setting
- Goal Setting – SMART definition
- Goal Setting – The SMART way
- Goal Setting – Vision & Planning
- Interprofessional Goals & Actions
Interventional Therapies
- Cochrane Evidence for CAM in Osteoarthritis
- Shock wave in treating pain
- The use of essential oils in treating pain
- Use of float therapy in treating pain
- Use of Massage therapy in treating pain
- Yoga in treating pain
Physical Activity
- “Z Sit” for back pain relief
- [YouTube Channel] Gentle Exercises and Relaxation techniques by Cara Kircher
- ECHO Stretches with pictures
- From Soup to Tomatoes: A Chair-Based Exercise Program
- Canadian 24-Hour Movement Guidelines:An Integration of Physical Activity, Sedentary Behaviour, and Sleep
Physical Therapy
Psychosocial Therapy
- Relaxation Audio – A 3 part exercise in releasing tension and relaxation
- Self Management Resources in Ontario
- Sleepwell – CBTi
Self-Management
- [Patient handout] My Action Plan
- BounceBack is a free skill-building program designed to help manage symptoms of depression and anxiety
- Online Chronic Disease Self-Management Program
- Pain BC Toolbox
- Pain BC’s Live Plan Be
- The Pain Toolkit
Articles
- “Yubi-wakka” (finger-ring) test
- Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines
- Osteopathy in treating pain
Pharmacological Therapies
Non-Opioids
- Benzodiazepines: How they work and how to withdraw (The Ashton Manual)
- Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society (CPS). Moulin et al. (2014)
Opioids
- [eBook] Demystifying opioid conversion calculations
- Converting from Transdermal to Buccal Formulations of Buprenorphine: A Pharmacokinetic Meta-Model Simulation in Healthy Volunteers. Priestley et al. (2017)
- Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions
- HQO Quality Standard – Opioid Prescribing for Acute Pain
- HQO Quality Standard – Opioid Prescribing for Chronic Pain
- HQO Quality Standard – Opioid Use Disorder (Care for People 16 Years of Age and Older)
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Managing Opioid Withdrawals – Drs. Squire & Jovey
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Patient handouts – Opioid tapering
- Tapering Opioids using motivational interviewing
Opioids and Pain Management Essentials
- [eBook] Demystifying opioid conversion calculations
- A pharmacist framework for implementation of the Canadian Guideline for Opioids for Chronic Non-Cancer Pain. Murphy et al. (2019)
- Canadian Opioid Prescribing Guideline for Chronic Non-Cancer Pain. Busse et al. (2017)
- CDC Guideline for prescribing opioids for Chronic Pain – United States (2016)
- Essential Clinical Skills for Opioid Prescribers. Women’s College Hospital. (2018)
- Opioid and Medication Treatment Agreement – Centre for Mental Health and Addiction and Interprofessional Pain and Addiction Recovery Clinic
Opioid Substance Use Disorders and Aberrant Behaviour
- Canadian Opioid Guideline (2017)
- CRISM National Guideline for the Clinical Management of Opioid Use Disorder. (2018)
- Management of opioid use disorders: a national clinical practice guideline. Bruneau et al. (2018)
- Opioid Aberrant Behaviour Tracker
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Opioid Taper Template. RxFiles (2018)
- Treating opioid use disorder in primary care. Perry, Orrantia and Garrison (2019)
Opioid Tapering
- Canadian Opioid Guideline (2017)
- Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Murphy et al. (2018)
- Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions
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Opioid Tapering Patient Pamphlets – developed by Mary Nelson
- Tapering opioids using motivational interviewing
- Tapering opioids using motivational interviewing. Crawley et al. (2018)
- What interventions are effective to taper opioids in patients with chronic pain? Sandhu (2018)
Buprenorphine/Naloxone (Suboxone)
- Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline
- Patient Handout DAY 0: Suboxone (buprenorphine/naloxone) Induction
- Patient Handout Day 7: Suboxone (buprenorphine/naloxone) Induction
- Suboxone (buprenorphine/naloxone) Protocol (used at TRI)
- Suboxone (buprenorphine/naloxone) Treatment Agreement
- [eBook] Demystifying opioid conversion calculations
- Buprenorphine/Naloxone: What and How?
Opioids
- [eBook] Demystifying opioid conversion calculations
- Canadian Opioid Guideline (2017)
- [Video] Canada’s Opioid Crisis – Learn about Opioids and the health risks. Government of Canada
- Chronic Pain Anonymous (CPA)
- Combined use of opioids and gabapentin
- Empower trial – Empowering older adults to reduce benzodiazepine use
- Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions
- Interview with Brian Goldman: Kirk Foat & Andrea Furlan
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Opioid Tapering Patient Pamphlets – developed by Mary Nelson
- Sensible Tools for Addiction Recovery
- Tapering opioids using motivational interviewing
- All About Opioids: Tapering, Rotating and The Spectrum of Opioid Use
Substance Use
- Clinical Opiate Withdrawal Scale (COWS)
- DSM-5 Worksheet: Updated Criteria for Diagnosis of Opioid Use Disorders
- Opioid Risk Tool (ORT)
- Effect of smoking status and nicotine dependence on pain intensity and outcome of treatment
- Smoking and Pain: Pathophysiology and Clinical Implications
- Smoking Cigarettes as a Coping Strategy for Chronic Pain is Associated with Greater Pain Intensity and Poorer Pain-Related Function
- Article on pain and smoking
Pain Assessment
General Pain Assessment
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Brief Pain Inventory (Short Form)
- Faces Pain Scale-Revised (FPS-R)
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Male and Female Pain Template
- Pain Explanation and Treatment Diagram – What are your pain risk factors?
- Wong Baker Faces Pain Scale
- The Pain Toolkit
- Pain BC Toolbox
- Pain BC’s Live Plan Be
- Everything You Need to Know About Chronic Pain
- The revised FLACC observational pain tool improved reliability and validity for pain assessment in children with cognitive impairment
- Assessment Tools & Clinical Guidelines
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Herr, Keela, et al. “Pain assessment in the nonverbal patient: position statement with clinical practice recommendations.” Pain Management Nursing 7.2 (2006): 44-52. https://geriatricpain.org/sites/geriatricpain.org/files/wysiwyg_uploads/aspmn_position_statement_pain_assesement_nonverbal.pdf
Post-Stroke Pain
- Canadian Best Practice Stroke Guidelines Post-Stroke Central Pain Guidelines
- https://www.strokebestpractices.ca/recommendations/stroke-rehabilitation/rehabilitation-to-improve-central-pain
Psychological Factors
- Clinical Administered PTSD Scale (CAPS-5)
- Disability Distress Assessment Tool (DisDAT)
- Identifying Abnormal Grief
- Mental Health Screening Tools
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Patient Health Questionnaires (includes PHQ-9 and GAD-7)
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- PHQ9 Screening tool
- GAD-7 Screening Tool
- Link to all PHQ GAD screeners
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Psychosocial Screening Interview
- PTSD Checklist for DSM-5 (PCL-5)
- The Pain Stages of Change Questionnaire (PSOCQ)
- Mental Health Resources
- Database Analysis of Depression and Anxiety in a Community Sample-Response to a Micronutrient Intervention
Sleep Resources
- [Sleep Apnea] STOP-Bang Questionnaire
- Relaxation Audio – A 3 part exercise in releasing tension and relaxation
- Self-managment-resources-in-Ontario
- Sleepwell – CBTi
Education Resources – For Healthcare Professionals
- Mnemonic for Borderline Patient Management (ADOBE)
ADOBE
Acknowledge feelings (Your anger or your patient’s anger)
Discover meaning (What your anger or patient anger means)
Opportunity to express empathy (for patient and for you as a clinician)
Boundaries (Set them clearly)
Extend the system (and not yourself)
Educational Resources and Tools – For Patients
- [Video] Introduction to Good Brain Bad Brain Chronic Pain by Michael Coupland
- [Video] Pacing: Your Superpower Against Chronic Pain
- [Video] Tame the Beast – It’s time to rethink persistent pain
- [Video] The Mystery of Chronic Pain: Ted Talk by Elliot Krane
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[Video] Understanding Pain: Brainman stops his opioids
- [Video] What is Chronic Pain and how is it different from regular pain?
- [YouTube Channel] Let’s Talk about Pain with Dr. Furlan
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My Opioid Manager
Articles on physician communication skills (general)
- AHRQ Strategy 6G – Training to Advance Physicians’ Communication Skills (2017)
- Ranjan P, Kumari A, Chakrawarty A. How can Doctors Improve their Communication Skills?. J Clin Diagn Res. 2015;9(3):JE01-JE4. doi:10.7860/JCDR/2015/12072.5712
- King A, Hoppe RB. Best practice” for patient-centered communication: a narrative review. J Grad Med Educ. 2013;5(3):385-393. doi:10.4300/JGME-D-13-00072.1
- Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.
Articles on communication in Chronic pain
- [Closed Access] Butow P, Sharpe L. The impact of communication on adherence in pain management. Pain. 2013 Dec;154 Suppl 1:S101-7. doi: 10.1016/j.pain.2013.07.048. Epub 2013 Aug 6. PMID: 23928026.
- Gupta, A. (2015). The Importance of Good Communication in Treating Patient’s Pain. AMA Journal of Ethics
- Whitten CE, Evans CM, Cristobal K. Pain Management Doesn’t have to be a Pain: Working and Communicating Effectively with Patients who have Chronic Pain. Perm J. 2005;9(2):41-48. doi:10.7812/tpp/04-140
- [Clinical Tool] Communicating About Chronic Pain: Instructions for Clinicians – VHA Office of Patient Centered Care and Cultural Transformation
Motivational Interviewing examples (role play)
- [Video] BMJ Learning – Motivational Interviewing in brief consultation: role play focusing on engaging (6m48s)
- Intro to a learning module on communication from BMJ Learning
- [Video] RNAO – Using Motivational Interviewing Approaches (16m02s)
Chronic Pain Communications
- [Video] Pain Week – Issues in Patient Provider Communications on Chronic Pain (5m06s)
- Patients with pain often report feeling discounted by health care providers, family, coworkers and caregivers. Dr. Geraghty comments on the etiquette of successful patient communication so that patients feel validated and better treatment outcomes are achieved
Virtual care
- Instructional video on conducting virtual physical exams: http://medicine.stanford.edu/news/current-news/standard-news/virtual-physical-exam.html
Positioning
- Positioning Techniques in Long-Term Care – RNAO: https://rnao.ca/sites/rnao-ca/files/Positioning_Techniques_in_Long-Term_Care_-_Self-directed_learning_package_for_health_care_providers.pdf