Bury Integrated Pain Service MEDICATIONS Medications and Persistent

Bury Integrated Pain Service MEDICATIONS

Medications and Persistent Pain People commonly expect to be given medication to get rid of their pain Medicines generally and opioids in particular are often not very effective for persistent pain Not always helpful, don’t get rid of the pain and cause unpleasant side effects

Why Don’t They Work? Persistent pain is complex, and can have more than one cause Individual medications tend to only work on one cause You can develop a tolerance to medication so you need increasing amounts to get the same benefit

Side Effects All medications have the potential to cause side effects – unwanted symptoms caused by the medication They vary from person to person and in how severe they are Medication leaflets list the known side-effects and how common they are

Types Non-opioids Weak Opioids Strong Opioids Neuropathics

Non-Opioids Paracetamol Non-steroidal anti-inflammatories (NSAIDs) Normally have minimal side-effects Are very effective for many people – particularly if taken earlyon

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) Aspirin Ibuprofen Naproxen Available in different forms – tablets/gels/creams Widely used and helpful for joint and muscle pain

Opioids A group of medications related to morphine Commonly divided into weak (e. g. codiene) and strong opioids (e. g. morphine, Fentanyl) Can be very helpful for short-term pain (for example after an operation) We now know they are less helpful for long-term pain – and can actually make it worse!

Opioids - Side Effects It is generally the case that the stronger the medication the more side-effects people are likely to experience. Common Side Effects • Depression • Anxiety • Increased infections • Constipation • Drowiness • Increased pain

Neuropathic Medications • Tricyclic Antidepressants • Amitriptyline • Nortriptyline • Anticonvulsants • Gabapentin • Pregabalin • Serotonin-norepinephrine reuptake inhibitor (SNRI) • Duloxetine

Neuropathic Medications Not originally designed to treat pain but have been found to be helpful with pain relating to the nerves (e. g. sciatica) Common Side-effects • Problems with thinking clearly • Dizziness, • Tiredness • Weight gain, water retention or bloating • Changes in mood and emotions, includes depression

You and Your Medications Decisions about pain medicines are important and not always simple and straightforward. These decisions need to be shared, between you and your prescriber.

You and Your Medications It is helpful to keep a record of which medicines you have used, the dose, for how long, how you responded to it and why you stopped it. This can help you and your prescriber make decisions about your medications

You and Your Medications Things to consider: Are you taking your medication but still experiencing high levels of pain? Do the side effects you are getting from the medication outweigh the benefits? Have you thought about reducing your medications?

You and Your Medications Don’t just stop taking your medications – discuss it with your prescriber Many medications need to be gradually reduced It is not always the case that we look to replace one medication with another Often self-management strategies are more effective in the long term