Management Principles for chronic non cancer pain
What is Chronic pain?
• Is pain persisting beyond 3 months
• Is real but does not always reflect the extent of tissue damage
• Is always influenced by central nervous system processes (including sensitisation, emotions, and thoughts) and the environmental context in which it occurs.
• There is little evidence that opioids are helpful for chronic pain, especially long term and there is strong evidence that opioids can be harmful
• Medications, in isolation, have a limited role
• Procedural interventions, in isolation, have a limited role
Chronic pain is best managed using a multidimensional approach
• Recognise, assess and treat as a chronic condition as early as possible
• A multidisciplinary approach to treating a chronic condition addresses physical activity along with psychological, social, nutritional and environmental aspects
• Consider utilising a coordinated multidisciplinary GP management plan, and Team Care Arrangement where appropriate, as active pain management strategies can be taught by a range of health care providers
• The management plan should aim to improve function and over time this may reduce pain
Flags for concern**
• Escalating medication dosage
• Opioid use exceeding 40mg morphine per day, equivalent to oxycodone 30mg or a 12mcg/hr fentanyl patch, per day.
• Opioid use >90 days
• Benzodiazepine use
• High psychological distress K10 >19
• Persisting unhelpful beliefs
• Declining function, avoidance of work, school, socialising, interests