Choosing Wisely Canada | Neurology

The Canadian Neurological Society / Choosing Wisely Taskforce has compiled a list of Seven Tests / Treatments to Question in Neurology. December 2019.

Seven Things Physicians and Patients Should Question

  • Don’t routinely perform brain imaging after acute seizure in patients with established epilepsy.
  • Don’t treat women of childbearing potential with Valproic acid if other effective treatments are available.
  • Don’t choose opioids or cannabinoids as the first choice of treatment for neuropathic pain.
  • Don’t order neuroimaging or EEG in asymptomatic patients in the emergency department with syncope and a normal neurological evaluation.
  • Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule).
  • Don’t use opioids for treatment of migraines.
  • Don’t use butalbital, butorphanol, or ergotamine as treatment for migraines except as a last resort.

Visit the Choosing Wisely website for all details including; reasoning, resource documentation and background of list creation.

The Canadian Neurological Society / Choosing Wisely Taskforce contributed to the published list of recommendations to "OPIOID WISELY"  -  A campaign that encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing. March 2019.

"OPIOID WISELY" 

Don’t choose opioids or cannabinoids as the first choice of treatment for neuropathic pain.

Opioids and cannabinoids have weak or inconclusive evidence in effective treatment of neuropathic pain. The well documented risks of opioid and cannabinoids include nausea, sleepiness, impairment, dependence, and development of substance use disorders. With impairment comes further risks to oneself and others in altered judgement in the workplace or while operating a vehicle. Opioids come with an additional risk of decreased respiratory drive and fatality with overdose. Neuropathic pain can be treated effectively using agents with demonstrated efficacy and significantly less risks compared to opioids and cannabinoids.

Don’t use opioids for treatment of migraines.

Opioids are not adequate for pain control for patients with migraines. The risk for harm, including impairment, dependence, tolerance, medication overuse headaches, and opioid use disorder with opioids is greater than the documented benefit. Additionally, opioids may worsen nausea and vomiting associated with the migraine. Prescription opioids for migraines would have minimal to no benefit with the excess of risk, and contribute to the opioid crisis.

Full campaign details available here: https://choosingwiselycanada.org/campaign/opioid-wisely/