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 
- 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 :
- 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
 J. C. Ballantyne and N. S. Shin, “Efficacy of opioids for chronic pain: a review of the evidence,” 2008.
 C. Hayes, A. Powell, and R. Burstal, “Reconsidering Opioid Therapy,” Health Professional Resources Hunter Integrated Pain Service. 2014.
 Guideline for prescribing opioids for chronic pain, Centers for Disease Control and Prevention, Available 2017