Chronic Pain medication review
30 minute appointment to review pain medication, discuss more suitable options and agree a medication treatment plan and lifestyle prescription
Chronic pain and opioids
The number of prescriptions issued for strong opioids such as, morphine, oxycontin and fentanyl, in the UK to treat long-term pain has increased significantly. However, evidence increasingly suggests that they cause significant side effects, which can result in a reduced quality of life.
When we shift our focus and prioritise improving function, the ability to sleep and work, or depression, anxiety and social isolation, rather than just the experience of pain, then non-pharmacological management interventions seem just as viable as opioids.
In the UK, it is estimated that 33–50 percent of the population is affected by chronic pain, and a recent survey of 4000 adults (aged 16-75), conducted by BBC News, suggests that 25 percent of us are living with pain.
Stephanie Kenzie
Specialist Prescriber Pharmacist
what we offer
A 30 minute appointment to review your pain medication helping to inform you of the potential harm opiates can cause, a plan to come off opiates if this is agreed and long term support with this.
Are you worried about the potential harm opiates can have on you and your quality of life?
Would you like to learn about possible alternatives to opiates to help manage chronic pain?
Has your GP discussed coming off or reducing opiates and you are concerned about how this will be managed? We can provide a plan that suits you and provide support throughout this journey.
We will work with your GP and write a letter recommending an agreed reduction plan to prescribe if they agree or we can prescribe with regular reviews keeping your GP up to date with the changes.
Pharmacological management of chronic primary pain
NICE recommends the use of antidepressants such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline for the pharmacological management of chronic primary pain for adults.
These antidepressants, when used in the management of chronic primary pain, may improve quality of life, pain control, sleep disturbances and psychological distress, even in the absence of depression. You may want to consider a trial period and agree a set of assessment criteria based on functional outcomes, rather than focusing only on level of pain.
Definition and epidemiology of chronic pain
Pain generally can be described as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. However, it is considered as a distinct condition rather than just a symptom of another medical condition.
Chronic pain, also known as long-term or persistent pain, is any pain that is present for more than three months. It may be secondary to an underlying condition, such as rheumatoid arthritis, osteoarthritis or endometriosis (termed ‘chronic secondary pain’), or it may have no identifiable underlying cause (termed ‘chronic primary pain’).
The progression to chronic primary pain can be characterised as sensitisation leading to pain, which feels increasingly severe despite the body not being further damaged. The brain and nervous system flash a warning signal, without there necessarily being any danger – like a car alarm going off when someone walks past.
Despite the poor evidence for opioids providing long-lasting reduction in pain and function, the number of prescriptions for opioids for chronic pain is increasing. A study in 2020 found that 14.6 percent of opioid-naïve people became long-term opioid users within a year of their first opioid prescription, highlighting the potential for dependence.
In 2020, the UK Medicines and Healthcare products Regulatory Agency (MHRA) released a drug safety update on the risks of dependence and addiction associated with the use of opioids.
Chronic pain affects between one third and one half of the UK population. This is likely to rise further with an ageing population. According to a systematic review of 19 studies, including 139,933 adults living in the UK, 10.4–14.3 percent of those living with chronic pain were found to have moderate-to-severe disabling pain.
For more information on what pain is, watch this short clip by Dr Patrick Hill:
NICE advises that the following drugs should not be initiated in the management of chronic primary pain:
The role of opioids in the management of chronic pain
Poorly controlled chronic pain not only leads to a decreased quality of life, but may also result in depression, anxiety, insomnia, substance abuse, mood disorders, worsening of existing chronic diseases, and an increased risk of suicidal ideation associated with both chronic pain and opioid use.
A retrospective study of people living with chronic pain concluded that those prescribed a morphine daily dose equivalent to or greater than 100 mg had a higher suicide risk. The study also concluded that this risk didn’t vary much between levels of opioid dosage.
Deprescribing opioids in people with chronic pain – Book 1
NICE concluded that there was no evidence for the efficacy of opioids when used for chronic primary pain, with an increased risk of dependence associated with opioid use for longer than six months.
The best available evidence suggests that exercise programmes and physical activity, psychological therapies and acupuncture are effective management options for chronic pain.
Pain management strategies
Self-management strategies that people living with pain can adopt include: