Persistent Pain - Pain Relief
Pain Medication (From the Southern Health Pain Team Website)
Medication is one of a number of strategies that may help with your pain. However, it is unlikely that medication alone will treat or cure your chronic pain. Some medication may reduce the intensity or the frequency of chronic pain but do not completely abolish it. This means that they may “turn the volume of pain down” and should be part of a wider Pain Management Plan, your personal Pain Management “Toolkit”. (See the persistent pain page)
Each medication works differently for each person and may result in some side effects and sometimes longer-term risks which must also be considered when deciding to take them. Sometimes they help, others may have no benefit or simply cannot be tolerated. If they help to a small degree, this effect may also be short lived. It’s unlikely that medication will reduce the pain as much as we would all ideally like.
Types of Pain Relief for Persistent Pain
There are different types of pain medications. More information is given in the Southern Health pain management services and on the faculty of pain site.
- Paracetamol
- Non-steroidal anti-inflammatories e.g. ibuprofen, naproxen, diclofenac
- Weak opioids e.g. codeine, dihydrocodeine
- Stronger opioids e.g. tramadol, morphine, oxycodone, fentanyl (see below)
- Neuropathic (nerve-type pain relief, often used inpersistent pain too), divided into those drugs that can also be used for antidepressants e.g. amitryptiline, nortryptiline, duloxetine, venlafaxine and those that can be used as anti-convulsants e.g. pregabalin, gabapentin
- Muscle relaxants e.g. Diazepam, baclofen
- Topical creams and plasters e.g. lignocaine (local anaesthetic), voltarol creams (NSAID), capsaicin patches
SO WHAT ARE MY OPTIONS?
Have you been on pain medications for over 3 months?
It is time to book an appt with your GP.
After 3-6 months your body would have healed or settled as much as it is going to. Taking medication for longer runs the risk of you becoming unintentionally addicted.
"The term ‘painkiller’ is misleading – it implies that medicine will kill the pain completely. Although they can play a part in managing persistent pain they do not work for everyone, and even if you get some benefit, after 3 months they’re probably not working and addiction becomes a serious issue." Check out the website painkillersdontexist.com
The Pain Management Service specialises in chronic or persistent pain and helping patients to manage their long-term pain conditions in the South West Hampshire region.
Below are links to information for pain relief commonly used in persistent pain from the faculty of pain patient information leaflets
OPIATES & CANNABINOIDS
OPIATES
"Living with and managing persistent pain, every, single day can be exhausting. Unfortunately, there simply isn’t a medication that will remove all pain. Taking opioid pain medication in the hope it will relieve most of the pain is not the answer."
https://painkillersdontexist.com/about/
A word on opitaes in persistent pain from the Faculty of Pain Medicine:
"Key Messages
- Opioids are very 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 or persistent pain.
- A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be 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 an oral morphine equivalent of 120mg/day, but there is no increased benefit: tapering or stopping high dose opioids needs careful planning and collaboration.
- If someone has pain that remains severe despite opioid treatment it means they are not working and should be stopped, even if no other treatment is available.
- Chronic pain is very complex and if 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."
CANNABINOIDS
A word on cannabinoids in persistent pain from the Faculty of Pain Medicine:
"Key messages:
There is not yet enough information on whether these drugs are safe, or effective to use forlong-term pain, and further research is needed urgently. Until we know more, treatments containing cannabis or cannabis-like medicines they should not be prescribed, unless a patient is taking part in a clinical study"
SLEEPING TABLETS & MUSCLE RELAXANTS
SLEEPING TABLETS
As already mentioned on the persistent pain page, sleep is really important to a whole person approach to managing persistent pain.
However, generally speaking, Doctors will try to avoid prescribing sleeping tablets due to concerns about their safety.
Medications are sometimes prescribed for just for a few days if insomnia is severe, disabling or causing extreme distress.
There is limited evidence for the effectiveness of long term medications in the treatment of insomnia and there can be side effects including drowsiness, dependency, tolerence, rebound insomnia and increased risks in older people such as cognitive impairment and falls.
See the sleep page for other things that can help and the patient.co.uk page.
MUSCLE RELAXANTS
Muscle relaxants are used to relieve muscle spasms which may result from some conditions which affect the nervous system. Conditions which may cause muscle spasms include multiple sclerosis, motor neurone disease and cerebral palsy. Muscle spasms and tightness may also follow long-term injuries to the head or back. Muscle spasm can also occur as part of a more short-term condition or injury, such as low back pain or whiplash. Medication helps the muscles to relax, which may also reduce pain and discomfort.
Sometimes a GP may prescribe a short course e.g. 3 days of muscle relaxants if it is thought that muscle spasm could be contribtuing to symptoms.
Patient.co.uk has a page with more information on muscle relaxants.
Updated by Dr Nichola Osborne April 2023
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