PEBC MCQ Pain, Musculoskeletal & Rheumatology question: Canadian Guideline for Opioids for Chronic Non-Cancer Pain

PEBC MCQPain, Musculoskeletal & Rheumatology

Under the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, for a patient starting opioid therapy, below what daily dose is it strongly recommended to restrict prescribing?

a. 90 mg morphine equivalent
b. 30 mg morphine equivalent
c. 200 mg morphine equivalent
d. 500 mg morphine equivalent

Show the answer and explanation

Answer: a. 90 mg morphine equivalent

The 2017 Canadian guideline makes a strong recommendation to restrict the prescribed dose to less than 90 mg morphine equivalent per day for patients starting opioid therapy, and a weak recommendation to restrict it to less than 50 mg. The older 200 mg 'watchful dose' from the 2010 guideline was replaced. For patients already above 90 mg, a gradual taper to the lowest effective dose is suggested. Source: Busse JW et al. 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain (CMAJ 2017;189:E659), recommendations 6-7.

Common mistake

Quoting the superseded 200 mg watchful dose.

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