Search Wye Valley NHS Trust

Medication

 

For most pain conditions, pain medication is a choice for symptom relief rather than a necessity to stop a disease process.

Any treatment with medicines results in a balance of benefits and harms; if the medicine doesn’t relieve the symptoms then the result of taking the medicine is harm only.

Medication can be helpful in acute or short-term pain, and may be used in persistent pain but the latest research shows us that pain medications can become less effective over time and also cause unpleasant side-effects, even increasing sensitivity to pain.

That is why it is important to incorporate other support mechanisms for pain management, such as exercise, relaxation and setting achievable, enjoyable goals in line with medication. Think ‘Skills before pills’. Our Pain Management Programme helps to develop these skills and looks to offer support for pain medication reduction if you would think this would be of benefit to you.

If you feel a review of your medication regimen may be helpful or you have any medication or side –effect concerns then you should discuss these with your GP, Nurse or Pharmacist at your earliest convenience. To see the ‘Understanding Pain and Opioid Reduction’ Video, click here.

General advice for patients using pain medication:

  • Medication should only be taken as prescribed. Taking more than the prescribed dose can be dangerous, for example taking just 1 paracetamol per day more than the recommended 8 in 24 hours can cause serious, and potentially life threatening, damage to your liver over time.
  • Stopping some medications suddenly can cause unpleasant withdrawal symptoms. Medication should be reduced slowly where possible and under the advice of a medical professional.
  • If you have neuropathic pain (pain that is associated with the nerves), e.g. burning, pins and needles, or shooting pains, then an anti-neuropathic drug might be better for your pain.
  • Taking certain painkillers throughout the day at regular intervals as prescribed may be more effective than taking painkillers when the pain becomes too much. However, opioids may be best used during flare ups or reserved for the night time.
  • Opioid medication, such as codeine, tramadol, morphine, etc. can be helpful in acute pain, cancer pain or at the end of life. There is less evidence to suggest that they are helpful in chronic/persistent pain.
  • If you are taking opioid medication, such as oxycodone, fentanyl, buprenorphine or zomorph, which has over 120mg morphine equivalent per day you may be at increased risk with little benefit to pain relief. Ask your local pharmacist to work out your morphine equivalent intake.
  • The side effects of these medications can be disruptive to your life. Over time you may build a tolerance to opioids, making them less effective at relieving pain and actually increasing your sensitivity to pain.  

Warning: Always consultant your GP, nurse, or pharmacist before adjusting any medication

In trials most medications for pain only benefit 1 out of every 4 or 5 people with an average of 30% reduction in pain. Some pain does not respond to any painkiller.

Increased risks of taking opioid medications include risk of harm, including a wide range of side effects, worsening of pain and increased ‘all cause’ mortality.  Research from the USA shows that patients who take more than 100mg of morphine equivalent per day have a 7 times increased risk of death compared to patients who take 20mg per day or less, such as codeine 30mg four times a day. 

If you feel like your prescribed medication is too much or not enough please consult your GP, Nurse or Pharmacist.

If you are taking a lot of opioid medication then reducing can help to tackle these side-effects. Often people find that their pain is no worse if they reduce gradually.

Without some of the side-effects you might find life is easier, not more difficult.

Could your opiate medication be making you feel worse?

 

 

Do you have this symptom?

Is it causing you problems?

1.

Feeling sleepy in the day time

Yes / No

Yes / No

2.

Poor concentration or memory

Yes / No

Yes / No

3.

Worry that you are not safe to drive

Yes / No

Yes / No

4.

Feeling unsteady or falling

Yes / No

Yes / No

5.

Problems with breathing, or snoring at night

Yes / No

Yes / No

6.

Small pupil size

Yes / No

Yes / No

7

Low energy, feeling I “can’t be bothered”

Yes / No

Yes / No

8

Lots of coughs and colds

Yes / No

Yes / No

9

Constipation

Yes / No

Yes / No

10

Low mood

Yes / No

Yes / No

11

Pain is severe despite the medication.

Yes / No

Yes / No

12

If you miss a dose, or cut down your dose, your pain is worse, and you feel shaky, sweaty, fluey.

Yes / No

Yes / No

 

Warning:  Always consult your GP, nurse, pharmacist or local pain service before reducing opioid medication

Useful links: 

Prescription medication, UK Law and driving, click here 

Pain concern: how to take medication effectively, click here  

Taking Opioids, click here 

Could your medication be making you feel worse? click here to download the 'myths' about pain medication 

Understanding Pain and Opioid Reduction Video, click here

© Wye valley NHS Trust 2019