Opioid prescribing for chronic pain
Opioids are very good analgesics for acute pain and pain at the end of life but there is little evidence that they are helpful for long-term pain. Despite this, they are widely prescribed for this reason – opioid prescribing more than doubled in the period 1998 to 2018. This has been referred to as an opioid epidemic in the UK, similar but not at the same scale as the opioid crisis in the USA.
The harms of this prescribing are now better understood, and government is regulating further. The Medicines and Healthcare products Regulatory Agency will now ensure that packs of opioid medication carry clear warnings about the risks of addiction and dependence.
Doctors that specialise in pain have observed that over time the principles used in prescribing for acute pain and pain at the end of life have been applied to the field of chronic pain, despite a lack of evidence of effectiveness and the potential for harm.
Guidance from NICE is clear that opioids are not indicated for chronic pain, and guidance from the Royal College of Anaesthetists (the professional body for doctors that specialise in pain) has been clear about the harm that can be caused.
We have produced two patient videos that aim to describe the harms of strong opioid prescribing in chronic pain.
Faye’s story puts these potential dangers into reality by describing, from her parent’s perspective, the sequence of events that ultimately led to her untimely death from respiratory depression. Faye’s story is also told in video form.
Sean’s story describes how strong opioid prescribing had a devastating impact on his quality of life, and how he has engaged with more effective non-drug therapy that has been life-changing.
Video for prescribers
Video for patients
National guidance and resources for clinicians and patients
- National Institute for Health and Care Excellence: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain
- Royal College of Anaesthetists, Faculty of Pain Medicine: Surgery and Opioids: Best Practice Guidelines 2021
- Live Well With Pain
- Other educational resources are also available and may be free of charge via your CCG Medicines Optimisation team:
- PrescQIPP CIC – Reducing Opioid Prescribing in Chronic Pain
Regional guidance and resources for clinicians and patients
We are pleased to see that in the South West of England there is a great deal of good work ongoing to review patients prescribed high dose opioids and we are signposting to this here.
Multimedia resources for patients, and prescribers
- Cornwall and Isles of Scilly STP – Chronic Pain in Cornwall
- Somerset STP – Pain Management
- Bristol, North Somerset, and South Gloucestershire STP – Chronic Pain guidelines
- Devon STP – Management of Opioids
- Dorset ICS – Dorset Opioid Prescribing for Chronic Pain: Resource Pack
- Gloucestershire ICS – the Living Well with Pain Programme
- Bath, Swindon & Wiltshire STP – Pain Management Guidance