AppMed
Chronic Pain & Opioids
A balanced, evidence-based overview of chronic pain and the role of opioid medications in its management — informed by current Canadian guidelines.
Section 1
Before You Read
The information presented on this page is provided by AppMed for general educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not constitute clinical guidance for prescribing, dosing, tapering, or stopping any medication.
Do not change, reduce, or stop any prescribed medication — including opioids — without first speaking with your physician, nurse practitioner, or pharmacist. Sudden changes in opioid dose can cause serious harm, including withdrawal, return of severe pain, and increased overdose risk if therapy is later resumed at the previous dose.
Content is summarized from publicly available materials of the Government of Canada (Health Canada and the Public Health Agency of Canada), the Canadian Pain Task Force, the Michael G. DeGroote National Pain Centre at McMaster University, the Canadian Pain Society, the Canadian Centre on Substance Use and Addiction, Pain BC, and Pain Canada.
Crisis support in Canada: If you or someone you know is in crisis, call or text 988 (Suicide Crisis Helpline). For overdose response, call 9-1-1. For substance use support: 1-866-585-0445 (Wellness Together Canada / Talk Suicide Canada).
Section 2
Table of Contents
Section 3
Understanding Pain & Treatment
What is Chronic Pain?
Chronic pain is pain that lasts longer than three months — beyond the time tissues normally need to heal — or pain that persists or recurs over a long period. It can result from injury, surgery, disease (such as arthritis or fibromyalgia), nerve damage, or sometimes without a clearly identifiable cause.1,2
Modern pain science recognizes chronic pain as a condition in its own right, not simply a symptom. It involves changes in the nervous system and is shaped by biological, psychological, and social factors.2,3
Common types include:
- Musculoskeletal pain — back pain, osteoarthritis, fibromyalgia
- Neuropathic pain — caused by nerve injury or disease (e.g. diabetic neuropathy, post-surgical nerve pain, sciatica)
- Headache disorders — chronic migraine, tension-type headache
- Visceral pain — chronic abdominal or pelvic conditions, endometriosis
- Pain related to chronic disease — cancer, inflammatory conditions, autoimmune disorders
Chronic pain often coexists with sleep problems, fatigue, low mood, anxiety, reduced mobility, and social isolation. Effective management typically requires a multidisciplinary approach — combining education, movement and exercise, psychological strategies, physical therapies, and, where appropriate, medications.3
What are Opioids?
Opioids are a class of medications that relieve pain by binding to opioid receptors in the brain, spinal cord, and other parts of the body. They reduce the perception of pain and may produce calming or euphoric effects.5,6
Some opioids occur naturally (for example, derived from the opium poppy), while others are semi-synthetic or fully synthetic. They may be prescribed for moderate-to-severe pain, severe cough, or — under specific conditions — to treat opioid use disorder.5,7
Examples of prescription opioids available in Canada:
- Codeine
- Morphine
- Hydromorphone
- Oxycodone
- Fentanyl (medical, e.g. transdermal patch — distinct from illicit fentanyl)
- Tramadol
- Methadone and buprenorphine/naloxone (also used to treat opioid use disorder)
Forms include tablets and capsules, liquids and syrups, transdermal patches, nasal sprays, suppositories, and injectable preparations.6
Tolerance and dependence are not the same as addiction. Tolerance (needing more for the same effect) and physical dependence (withdrawal if the drug is stopped suddenly) can occur with many medications and do not by themselves indicate opioid use disorder.7,8
Opioids in Chronic Pain Management
The role of opioids in chronic non-cancer pain has been carefully reassessed in Canada over the past decade. The current reference document is the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain, developed by the Michael G. DeGroote National Pain Centre at McMaster University and funded by Health Canada and the Canadian Institutes of Health Research. An update is in progress at the time of writing.9,10
Key points reflected in Canadian clinical practice:
- For most patients with chronic non-cancer pain, non-opioid therapies should be tried first — including physical activity, physiotherapy, cognitive-behavioural therapy, non-opioid medications (such as acetaminophen, NSAIDs, or specific neuropathic-pain agents), and self-management programs.9
- When opioids are considered, the guideline suggests using the lowest effective dose and being cautious about exceeding 50 mg morphine equivalents per day; doses of 90 mg/day or higher require especially careful evaluation.9
- Treatment should be individualized, with realistic functional goals, ongoing reassessment, and shared decision-making about benefits and harms.9
- Opioids are generally not recommended as first-line therapy for patients with active substance use disorder or significant psychiatric conditions, and require additional precautions.9
Tapering or stopping opioids should always be gradual and clinician-supervised. Abrupt or forced tapering is associated with serious harms including return of severe pain, withdrawal, mental-health deterioration, and increased overdose risk; Health Canada has explicitly cautioned against rapid involuntary tapering.10
Naloxone — a medication that can temporarily reverse an opioid overdose — is available free of charge through pharmacies and community programs across Canada. People prescribed opioids, and those close to them, are encouraged to obtain a take-home naloxone kit.11
Section 4
Frequently Asked Questions
How is chronic pain different from acute pain?
Acute pain is short-term, usually linked to an identifiable injury or illness, and resolves as healing occurs. Chronic pain persists for more than three months — sometimes for years — and may continue even after the original injury has healed. It often involves changes in the nervous system and is recognized as a condition in its own right.1,2
How common is chronic pain in Canada?
Approximately 8 million Canadians (roughly 1 in 5 adults) live with chronic pain. The prevalence rises with age — about 1 in 3 adults aged 65 and over are affected — and is higher among women, Indigenous peoples, and people living with social or economic disadvantage.3,4
Are opioids the best treatment for chronic pain?
Generally, no. Current Canadian guidance recommends that non-opioid therapies be tried first for chronic non-cancer pain — including exercise, physiotherapy, psychological therapies, and non-opioid medications. Opioids may be considered when other options have not provided sufficient relief, after a careful discussion of benefits and risks.9
What are the main risks of opioid medications?
Risks include constipation, drowsiness, nausea, falls, slowed breathing (which can be fatal), tolerance, physical dependence, opioid use disorder, and overdose. Risk increases with higher doses and when opioids are combined with alcohol, benzodiazepines, or other sedating substances.5,7,8
What is the difference between dependence and addiction?
Physical dependence means the body has adapted to a medication, so stopping suddenly causes withdrawal — this can occur with many drugs and is not, by itself, addiction. Opioid use disorder (addiction) is characterized by loss of control over use, craving, and continued use despite harm. Most people who take opioids exactly as prescribed do not develop opioid use disorder, but the risk is not zero.7,8
Can I stop my opioid medication on my own?
No — please do not stop or reduce a prescribed opioid suddenly. Abrupt discontinuation can cause withdrawal symptoms, return of severe pain, mental-health deterioration, and (if therapy is later resumed) a higher risk of overdose because tolerance is lost. Any change should be gradual and supervised by your prescriber.10
What is naloxone and where can I get it?
Naloxone is a medication that can temporarily reverse an opioid overdose. In Canada, take-home naloxone kits are available free of charge at most pharmacies and community programs, with no prescription needed in most provinces and territories. People taking prescribed opioids and their family members are encouraged to keep a kit accessible.11
Where can I find help if I'm struggling with opioid use?
Confidential support is available 24/7 across Canada at 1-866-585-0445. Your family doctor, nurse practitioner, pharmacist, or local public health unit can also connect you to evidence-based treatment, including opioid agonist therapy (such as buprenorphine/naloxone or methadone), which is highly effective.12
Section 5
Trusted Canadian Resources
Curated links to authoritative Canadian organizations for further reading, self-management, and support.
References
Sources & Citations
- Canadian Pain Society. About chronic pain — definition and impact. Available at: canadianpainsociety.ca
- Government of Canada / Public Health Agency of Canada. About chronic pain. Available at: canada.ca
- Canadian Pain Task Force. An Action Plan for Pain in Canada (March 2021). Available at: canada.ca
- Canadian Pain Task Force. Chronic Pain in Canada: Laying a Foundation for Action (June 2019).
- Government of Canada / Health Canada. About opioids: side effects and risks. Available at: canada.ca
- Government of Canada / Health Canada. Opioid pain medications. Available at: canada.ca
- Government of Canada / Health Canada. Opioid pain medications — Frequently Asked Questions. Available at: canada.ca
- Government of Canada / Health Canada. Opioid use disorder and treatment. Available at: canada.ca
- Busse JW, Craigie S, Juurlink DN, et al. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017;189(18):E659–E666. Michael G. DeGroote National Pain Centre, McMaster University. Available at: npc.healthsci.mcmaster.ca
- Health Canada. Statement on Opioids and Pain Management (November 2022) — caution regarding rapid tapering and announcement of guideline update. Available at: canada.ca
- Government of Canada / Health Canada. Naloxone — How and where to get a take-home naloxone kit.
- Canadian Centre on Substance Use and Addiction (CCSA). Opioids — guidance, tools and resources. Available at: ccsa.ca
Last reviewed: April 2026. Content is provided for educational purposes by AppMed and is not a substitute for individualized medical advice. The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain is currently being updated by McMaster University with Health Canada funding; please consult a qualified Canadian health care professional for guidance specific to your situation.
AppMed · Chronic Pain & Opioids Module
© AppMed. Educational content based on Canadian clinical guidelines.