Around 20% of Australians suffer from chronic pain. Chronic pain may be defined as constant daily pain that is present for at least three months. The condition can be the result of trauma, cancer, auto-immune diseases, or arthritis. However, sometimes there is no obvious cause. When inadequately treated, chronic pain can impair cognitive processes, mental health, cardiovascular health, sleep, interpersonal relations, and overall quality of life
The Therapeutic Guidelines: Analgesic encourages the use of non-pharmacologic treatments and regular doses of paracetamol for the management of chronic non-cancer pain. Due to the potential for major adverse effects, nonsteroidal anti-inflammatory drugs (NSAIDs) should only be used at the lowest effective dose for the shortest treatment period possible. Analgesic adjuvants, including some antidepressants, anticonvulsants, and skeletal muscle relaxants, may also be considered.
Although there is insufficient evidence to support the long-term use of opioids in chronic non-cancer pain, these medications are commonly prescribed. The Drug Utilisation Sub-committee (DUSC) conducted a review of opioid use in Australia between 2009 and 2014 and found a steady increase in the use of opioids in our community. If opioids are considered necessary, the guidelines recommend initiation with modified release morphine or oxycodone, or transdermal buprenorphine.
Chronic pain is a complex condition and treatment needs to be tailored to the individual. Complete relief of pain is often not achievable. However, effective pain management programs can reduce suffering and improve quality of life.
- Analgesic Expert Group. Chronic pain: overview [revised November 2012]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2016.
- Australian Commission on Safety and Quality in Health Care. Opioid medicines. In: Australian Atlas of Healthcare Variation. Sydney: ACSQHC; 2015.
- Drug Utilisation Sub-Committee. Opioid analgesics: overview. Canberra: Department of Health; 2014.