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Chronic Pain Treatment Options

Recognise, assess and treat as a chronic condition

  1. Reassure - increased pain is not indicating new pathology
  2. 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
  3. 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

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