Managing Chronic Pain

·         Pain that lasts for more than 3 months is known as chronic or persistent pain. It is common and affects between 3 and 5 in every 10 people. Chronic pain can be caused by an underlying condition (for example, arthritis or endometriosis); this is known as chronic secondary pain. But in many cases the cause of the pain is unclear; this is called chronic primary pain. Pain is complex and many factors can affect or be affected by the pain, including your work and leisure time, relationships with family and friends, sleep and mood. Management of chronic pain should be individualised with a focus on self-management and maintaining daily function and quality of life despite ongoing pain.

·         Unlike acute pain, chronic pain is difficult to treat with most types of medication helping less than a third of patients. Medicines generally and opioids in particular are often not very effective for chronic pain.

·         Most treatments aim to help you self-manage your pain and improve what you can do. Some non-medicine treatments may be used such as electrical stimulating techniques (TENS machine), acupuncture, advice about activity and increasing physical fitness, and psychological treatments such as Cognitive Behaviour Therapy and meditation techniques such as mindfulness.

·         Helping you understand about chronic pain is important and in particular helping you understand that physical activity does not usually cause further injury and is therefore safe. It is important that you understand that treatments tend not to be very effective and that the aim is to support you in functioning as well as possible.

Information is from the faculty of pain medicine website.

Resources to help you manage your chronic pain:

https://livewellwithpain.co.uk/resources-for-people-with-pain/

https://www.flippinpain.co.uk/understanding-pain/

https://www.paintoolkit.org/what-is-pain

Opioid Treatment for Pain

Opioids include codeine, tramadol, morphine, oxycodone, fentanyl, buprenorphine and methadone.

·         There is evidence to suggest that opioids are very good painkillers when used for cancer pain, pain at the end of life or if used short term (for days to a few weeks) for some types of acute pain.

·         Recent evidence has shown that opioids are poorly effective for long-term or chronic pain. As a result, opioid medication has been removed from a number of the guidelines that GPs use when treating chronic pain. For a small proportion of patients, opioids may be successfully used as part of a wider plan including non-medication treatments and self-management. If this is the case, best results are achieved when the opioids are used intermittently and at the lowest possible dose.

·         When opioids are used, it is important to understand that the aim is not complete pain relief but rather reducing pain sufficiently to engage in self-management.

·         The potential harms of opioid treatment include drowsiness, nausea, constipation, effects on hormones, effects on the immune system, the potential for the drugs to worsen pain, the potential for problematic drug use and addiction.

·         If the pain remains severe despite opioid treatment, it means that it is not working and should be stopped, even if no other treatment is available, as the risks outweigh the benefits.  

Resources to help you manage your chronic pain:

Information for patients | Faculty of Pain Medicine