Chronic pain and opioid use-myths and truths.

For those of us living with chronic pain, it is perfectly understandable to attempt to find the cause of the pain so that it can be suitably managed or treated. And alongside this searc

h for what is physically wrong, we also have a very strong desire to find the right combination of painkillers to reduce the pain as much as we are able.

The nature of chronic pain makes it an incredibly difficult condition to manage and treat. For example our perceived pain experience is made up of a combination of factors including physiological, psychological, behavioural, cognitive and emotional. This multifactorial approach to understanding pain perhaps illustrate part of the reason why it is very difficult to remove chronic pain with medication or medical intervention alone.

The strongest painkillers we have are called opiates and would include the likes of morphine and fentanyl. However even when we take these, it can often feel that opioids have very little effect. There are many for reasons for this which have been highlighted in Pain News (June 2017 volume 15 issue two Page 81 to 82) I shall now explore with you.

In the research, most randomised controlled trials on opioid therapy draw their conclusions on drug trials lasting 6 to 12 weeks. Only a few studies look at opioid efficacy for longer than this, and they consistently report poor results. A large observational study in Denmark showed higher pain intensity, interference from pain in life and worse quality of life for patients treated with opioids compared to those not treated with opioids. And in a longitudinal study of almost 68,000 postmenopausal women with persistent pain, those women with prescription opiates were more likely to report lack of improvement in pain and worsening physical functioning three years later.

And of course there has been much publication recently about opioid -related deaths and drug misuse.

Some of the lack of effectiveness for opioids in chronic pain may be down to some of us lacking a substance P receiver within our nervous system. However my belief is that if the experience of chronic pain is made up of all the elements I have highlighted in the opening paragraph, then chronic pain needs to be treated by addressing all of these layers. Chronic pain  cannot be treated by medication alone, nor can it be treated psychologically alone there has to be treatment based upon the emotional, cognitive, behavioural aspects of the individual as well as medication and medical interventions where appropriate and necessary.  Kim is a former pain management clinical nurse specialist and is now a counsellor specialising in chronic pain and long-term health conditions.  Please call to explore how she might be of use to you.