STRONG OPIOIDS IN NON-CANCER PAIN
Opioids are drugs derived from opium, a chemical present in some plants such as poppies. They are some of the oldest painkillers known to man, and have been used for many years to treat acute (short-term) pain. They are particularly effective after surgery or in the early days after an injury.
Unfortunately, we now understand that their effectiveness in long-term pain is very limited. They have a number of side-effects and other problems that limit their use in any pain condition that lasts more than a few weeks.
You may already be on strong opioids. If this is the case, and you wish to reduce the dose you are taking, your Bath Pain Management consultants will be able to support you in this. Dr Coupe has a particular expertise in the use of opioids in long-term non-cancer pain, and has co-authored a book on the subject, which can be found by clicking here.
Recognising the issues around the use of opioids, the Faculty of Pain Medicine of the Royal College of Anaesthetists has produced a website, Opioids Aware, to guide patients and health practitioners alike. The key messages are:
Opioids are good analgesics for acute pain and for pain at the end of life, but there is little evidence that they are helpful for long term pain.
A small proportion of people may obtain good pain relief with opioids in the long-term if the dose is kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).
The risk of harm increases substantially at doses above and oral morphine equivalent of 120mg/day, but there is no increased benefit.
If a patient is using opioids but is still in pain the opioids are not effective and should be discontinued even if no other treatment is available.
Chronic pain is very complex and of patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detailed assessment of the many emotional influences on their pain experience is essential.
Please contact us if you have any questions or wish to see a Bath Pain Management consultant to discuss your painkilling medications.