Medication Web Page
Medication has a role in the management of long term pain however it is only a piece of the Jigsaw and is not the solution. Times have moved on from “using stronger and stronger painkillers to get rid of the pain”. Evidence tells us that medication for pain will only help some people. Every person responds differently to medication, there is no way to know in advance. Therefore it is important when starting any new medication that there is a clear clinical reason (sometimes known as indication) to start it and that it is initiated as a trial with a planned review appointment to assess benefit ( sometimes known as efficacy). It can take time to find the right combination and dose of medications and when the right combination is found there needs to be ongoing assessment to see if it is still appropriate to continue.
There also needs to be awareness that pain medication will not get rid of the pain completely and that the term ‘painkillers’ is outdated in a persistent/chronic pain sense. Setting an expectation that a reduction of 20-30% in pain is a good outcome may be useful. Some people may find it hard to find any medication that is helpful or does not cause too many side effects, this does not mean that their pain cannot be managed or improved significantly by other pieces of the Pain Self Management Jigsaw such as applying pacing and keeping active.
With some pain medications there are risks of dependence and withdrawal issues. Patients should be informed of risks at initiation and assessed and offered appropriate support where possible if later identified as an issue. The Royal College of Anaesthetists (RCoA) have created a useful website with further information RCoA Opioids Aware website
National & Local Guidance
SIGN136 Management of Chronic pain ( add hyperlink http://www.sign.ac.uk/sign-136-management-of-chronic-pain.html
NHS Scotland & Scottish Government -Quality Prescribing Improvement Guide Quality Prescribing for Chronic Pain 2018
NHS Fife Formulary Appendix 4 C Guidance on the Management of Chronic Non-Malignant Pain add hyperlink http://www.fifeadtc.scot.nhs.uk/formulary/4-central-nervous-system/appendix-4c-chronic-pain-management-(overview).aspx
NHS Fife Formulary Appendix 4 G Strong opioids prescribing guideline & educational pack http://www.fifeadtc.scot.nhs.uk/formulary/4-central-nervous-system/appendix-4g-chronic-non-malignant-pain-strong-opioid-prescribing-guideline-and-educational-pack.aspx need to add new link once through ADTC
NHS Fife Formulary Appendix 4 H Quick reference guide: Opioids for chronic non-malignant pain http://www.fifeadtc.scot.nhs.uk/formulary/4-central-nervous-system/appendix-4h-quick-reference-guide-opioids-for-chronic-non-malignant-pain.aspx need to add new link once through ADTC
NHS Fife Formulary Opioid Withdrawal Guidance need to add link once through ADTC