1 June 2010

Chronic pain affects one in five Australians and costs the economy $34 billion per year. Opioids are an option for some patients with chronic pain but there has been a significant increase in the supply of prescription opioids over the last two decades.

The latest NPS therapeutic program, Opioid use in chronic pain: use a planned approach, explores ways of optimising the benefits of opioids in chronic pain while minimising the harms associated with inappropriate use. These include careful patient selection, clear communication about the goals of opioid therapy, careful advice about proper use and close monitoring.

“Opioids are an option for some patients with chronic pain, with their goals being to reduce pain and to improve function and quality of life. However they should only be prescribed as part of a comprehensive pain management plan developed in consultation with the patient,” NPS CEO, Dr Lynn Weekes said.

“Documenting the plan and outlining the terms for opioid use can prevent unsanctioned use and provide pre-agreed approaches if the patient experiences repeated episodes of breakthrough pain. Finally, it can help patients to be realistic about the goals of their treatment,” Dr Weekes said.

Long-acting opioids are recommended for chronic pain and short-acting opioids can be used to establish pain relief requirements. However the choice of opioid, initial dose and titration schedule should be developed in line with the patient’s health, age, response and past experience with opioids.

“In cases of non-specific low back pain, a thorough patient history and physical examination are critical in checking for red flag indicators of potentially serious underlying conditions. In the absence of red flags, imaging tests are not routinely recommended and are unlikely to improve patient outcomes or alter clinical decision-making,” Dr Weekes said.

As part of this program, health professionals are encouraged to:  

• perform a thorough history and physical examination to determine if investigations are necessary
• prescribe an opioid as part of an agreed pain management plan
• initiate an opioid only as a short term therapeutic trial
• continue an opioid in those who demonstrate benefit from a trial and regularly reassess the need for ongoing therapy
• discuss options for managing breakthrough pain.

The following resources have been developed for health professionals:

• NPS News (69): A planned approach to prescribing opioids
• Prescribing Practice Review (51): Opioids in chronic pain: use a planned approach
• GP and GP Registrar Clinical Audit: Review of opioid prescribing in chronic pain
• Pharmacy Practice Review: Optimal use of opioid-containing analgesics in chronic pain
• Case study: Opioid therapy in chronic pain—use a planned approach
• Drug use evaluation (DUE) tool: Opioid therapy for chronic non-cancer pain
• Pain management plan and diary for patients
• Counselling tool for patients: Using opioid medicines for your chronic pain
• One-on-one educational visiting and small group discussions by NPS facilitators
• Interactive workshop for residential aged care nurses.

For further information visit www.nps.org.au/health_professionals.