This Be Medicinewise Week (21–27 August) to help prevent medication misuse, health professionals are encouraged to take the time to better manage patients with acute pain developing into chronic pain. Evidence suggests that medicines are overused to treat chronic pain; however, some patients are still being prescribed opioids to manage their condition.
Dr Jill Thistlethwaite, Medical Adviser at NPS MedicineWise, says health professionals may continue prescribing opioids for chronic, non-cancer pain because better pharmacological options aren’t available. Additionally, health professionals may not consider non-pharmacological options.
“It is unlikely that any pain relievers will be able to completely stop chronic pain," said Dr Thistlethwaite. “It can be quite challenging seeing a patient in pain and needing something to alleviate their discomfort. GPs are limited to the pharmacological options available, which we know are largely ineffective in the long term, but may provide a temporary solution to what is unfortunately, and frequently, a long-term problem."
“Health professionals should do everything possible to help prevent patients from being overexposed to the potentially serious harms of opioids, which include side effects, and an increased risk of accidental overdose, dependence or addiction,” said Dr Thistlethwaite.
“Many Australians have seen or experienced physical dependency on a medicine. The good news is that health professionals can do something about it.”
Evidence-based pain management programs developed by NPS MedicineWise recommend that health professionals set a clear timeframe for the use of opioids at the beginning of treatment for acute pain if they are required. Initial conversations with patients can explore the possibility of persistent pain following their accident or injury, and the fact that opioids are not a long-term solution. If the pain persists past three months, health professionals should consider, in partnership with the patient:
- using a validated tool to assess pain and function
- following a multidisciplinary pain management approach, covering aspects such as physical fitness and activities, mood, sleep, relaxation and overall health
- encouraging patients to manage their pain and set functional goals
- prescribing analgesics only in small doses for short periods of time
- monitoring patients’ physical and mental conditions
- reinforcing the need to have a solid, continuing relationship with a single health care professional.
“Encouraging patients to start exercising as appropriate and to learn new coping skills are two important ways to help improve their functionality and reduce the impact of their pain. People who are informed and engaged in their self-management report improved moods, better general health and reduced use of medicines,” said Dr Thistlethwaite.
“If your patients would like to find out how to manage pain without relying on painkillers, and would like a reliable source of additional information, please encourage them to visit painaustralia.org.au.”
NPS MedicineWise offers evidence-based chronic pain management resources for health professionals at https://www.nps.org.au/medical-info/clinical-topics/chronic-pain.
One in five Australians, including children and adolescents, lives with chronic pain. This number rises to one in three for those over the age of 65.
Julia Proud is an example of someone who was prescribed strong pain relievers for much longer than intended and she is available for interview.
In October 2012, Julia was injured in a cycling accident in which she was hit by a car, fracturing her L1 vertebra.
Following surgery, Julia was prescribed opioids for 10 months. The side effects of the medicines were “horrendous”. She felt emotionally numb – “like a zombie”. This put a strain on her marriage and led to depression. She also grew dependent on the medicine, and would count down the minutes until she could take another dose.
In March 2015, following advice from her physiotherapist, Julia began a 10-week pain management course at Concord West Hospital pain clinic. She learned to control her pain through cognitive behavioural therapy, relaxation, diet, regular exercise and complementary treatments (chiropractor, acupuncturist, etc).
Today, Julia does not take painkillers.
Follow us on Twitter @NPSMedicineWise or Facebook http://www.facebook.com/npsmedicinewise. Health professionals can remind their patients that if they would like to know more about the medicines they take, they can call the Medicines Line on 1300 MEDICINE (1300 633 424).
The NPS MedicineWise Adverse Medicine Events Line (1300 134 237) is a service that encourages members of the public to report and discuss side effects that might be related to their medicine. The AME Line is available Monday to Friday, 9am to 5pm AEST (excluding public holidays/Christmas closure). It is not for emergencies. Alternatively suspected side effects can be reported directly to the TGA via their website. www.tga.gov.au
Eve Hanks 02 8217 8667, 0419 618 365 or [email protected] and Juliet Pisani-Forde (02) 8217 8249 or [email protected].
Independent, evidence-based and not-for-profit, NPS MedicineWise enables better decisions about medicines and medical tests.
We receive funding from the Australian Government Department of Health.