Chronic Pain Treatment Options
Recognise, assess and treat as a chronic condition
- Reassure - increased pain is not indicating new pathology
- Brief Education - especially regarding the causes and treatment of chronic pain [1]
- Pain flare-ups are not a sign of damage
- Opioids – tolerance and risk of harm (see below)
- Importance of self-management skills
- Treat – aim to improve function as well as reduce pain over time.
- Consider physiotherapy, beginning in the ED if available
- Consider referral to psychology, empathetic approach
- Consider time-limited medications* including opioids but with caution**
- Consider emergency management plan for repeat presentations.
* Time limited medication commensurate with their current prescription, can be used to help with the change to active self- management. Providesufficient to reach a GP the next working day
**For patients with chronic non-cancer pain, the evidence is that benefits of opioids are minimal in the long term and are associated with significant harms. Opioids should only be used when [2]:
- Other alternative therapies have not provided sufficient pain relief and
- Pain is adversely affecting a patient's function and/or quality of life and
- The potential benefits of opioid therapy outweigh potential harms.
If prescribed, opioids should be immediate release in the first instance, combined with non-opioid pharmacotherapy and non-pharmacologic therapies as appropriate.
Sustained release opioids should be reserved for severe, continuous pain and should be considered only for patients who have received immediate-release opioids daily for at least 1 week.
Further References and Resources
[1] J. C. Ballantyne and N. S. Shin, “Efficacy of opioids for chronic pain: a review of the evidence,” 2008.
[2] C. Hayes, A. Powell, and R. Burstal, “Reconsidering Opioid Therapy,” Health Professional Resources Hunter Integrated Pain Service. 2014.
[3] Guideline for prescribing opioids for chronic pain, Centers for Disease Control and Prevention, Available 2017