Chronic pain

Chronic pain is a difficult condition. Unfortunately, painkillers are unlikely to be the answer. They can also cause more problems. Although stronger painkillers can provide short-term pain relief, they have mistakenly been prescribed for long-term pain management.

Long-term pain arises through many different and varied mechanisms, and drugs tend not to work effectively on these. High doses of painkiller medicines taken for long periods are unlikely to give better pain relief and are associated with harmful effects. Benefits should outweigh the risks, and therefore, the Surgery is often reluctant to prescribe strong painkilling medication to patients with chronic pain.

Strong painkillers usually contain opioids or synthetic opioids. This group include drugs like morphine, fentanyl, buprenorphine, tramadol, oxycodone, OxyNorm and dihydrocodeine.

Please follow the link for additional information on managing chronic pain: Ways to manage chronic pain – NHS (www.nhs.uk).

It is important not to stop medications suddenly as it can cause withdrawal symptoms and, therefore, should be discussed with the GP on how to wean down the medication slowly and safely. The Surgery will often talk to patients (including newly registered patients) about their painkilling prescriptions for chronic pain to ensure that all medications issued in this Surgery are in the patient’s overall interests. We may work with patients to slowly reduce the overall quantities of opioids and synthetic opioids prescribed over many months (or years in some cases).

• Increased tolerance, which means you become more sensitive to pain, requiring high doses of the same medication to manage pain
• Dependency – difficulty stopping the medication or reducing medication without side effects ( agitation, anxiety, muscle aches, insomnia, sweating, abdominal pain, diarrhoea, vomiting, etc)
• It can cause drowsiness and mental fogginess/ confusion- this can be mistaken for relaxation; however, it does not reduce the pain experienced.
• Decreased immune function- increased risk of recurrent illness/ infection.
• Increased risk of falls/ fracture – opioids can increase the risk of osteoporosis (weakened bones), which can further increase pain
• Increased risk of depression and anxiety, which can negatively impact pain management.

Decreasing and slowly stopping opioid painkillers may help you experience less pain, increase activity/ improve your mood, feel less drowsy, and improve your energy levels, which will enable increased activity and exercise to help improve pain. The Surgery can offer advice on alternative approaches to pain management rather than relying on medication. Such approaches include acupuncture, exercise, physiotherapy, osteopath, Pilates, therapy, stress reduction, yoga, relaxation techniques, music therapy, hobbies, socialising, and massage. There is a range of less addictive medications that can assist with specific pain, general body pains, insomnia, etc.

Patients who are receiving established end-of-life care and have been accepted by the community palliative care team are prescribed all necessary painkillers.