Overview

A dedicated team run this outpatient clinic. It includes a pain consultant, nurse and clinical psychologist. At this clinic, we:

• review your pain condition, medical history and medicines, including opioid medicines such as morphine, fentanyl and oxycodone
• explain the risks and benefits of high-dose opioids
• make sure you have the best pain relief medicines
• help you to reduce high-dose opioids with our tailored weaning programme
• talk about other options for long-term pain management

We ask you to complete some questionnaires before your appointment. These tell us more about you, your pain, and how it affects you.

We might also do routine blood and urine (pee) tests.

Chronic pain

Pain is usually described as acute (short-term) or chronic (long-term or persistent).

Acute pain is caused by an obvious injury, such as a break (fracture) in the bone or surgery.

Chronic pain sometimes begins with an acute injury, but the pain does not get better as expected. Tissues and nerves can become over-sensitive and trigger pain long after the injury.

Chronic pain can affect your quality of life. It can make you feel low or irritable, cause suffering and poor sleep, and make it hard to function normally.

Medicines to treat chronic pain

Chronic pain (unlike acute pain) is difficult to treat because medicines are generally less effective.

Only 1 in 3 people with chronic pain respond to pain medicines. Even in this group, the pain level only reduces by up to half.

In fact, pain can be resistant to change with medical treatments. If we concentrate on medicines alone, we are focusing on one of the least changeable aspects of your long-term pain condition.

Medicines are only a small part of your overall treatment. They should be used together with other treatments to improve your physical, emotional and social wellbeing.

Opioids for chronic pain

Opioids (such as morphine, oxycodone, fentanyl and tramadol) have an important role in treating acute or short-term pain, and pain at the end of life. However, there is little evidence that they help long-term pain. There are also concerns about side effects.

All medicines including opioids involve some risk, particularly if you have high amounts (doses) or take different medicines together. Some medicines do not mix with other medicines. 

The risk of taking opioids depends on your dose and the type of opioid medicine that you take.

Patients and healthcare professionals should be clear who is responsible for prescribing opioids. There should only be 1 prescriber, and they are usually your GP.

Side effects of high-dose opioids

• Breathing problems. Opioids can slow down your breathing to a dangerous level and possibly lead to death. This is one reason why taking large doses is dangerous.
• Opioid-induced hyperalgesia. This is when high doses of opioids might make your pain worse instead of better. Something minor, like a pinch, could feel much worse and affect a wider area than it would if you were not on opioids.
• Tolerance. This is when you need higher and higher doses to get the same effect. It might explain why opioids are often not effective in the long term.
• Dependence. You might rely on opioids within 1 to 3 months of starting to use them. This might be a physical reliance when you feel unwell if you do not take the medicine. It might also be a psychological reliance when your mood can change drastically without the medicine.
• Immune suppression. Taking opioids can make it harder for your body to fight infections and heal wounds.
• Impaired hormone function. Taking opioids can affect your sex hormones. This can cause sexual problems, reduced sex drive, and infertility (meaning you or your partner cannot get pregnant).
• Osteoporosis. Taking opioids can make your bones thinner over time, and increase the risk of breaks in the bones.
• Depression and anxiety.
• Increased risk of heart disease and an abnormal heart rhythm.
• Blood sugar (glucose) problems. Taking opioids can cause glucose intolerance (when you have high blood glucose levels) and increase your risk of diabetes.
• Changes in the brain. If you use high-dose opioids in the long term, there might be changes in the brain. This can affect your memory and concentration.
• Headaches or migraines. If you use opioids every day, this can cause ongoing headaches or migraines.

Opioids with other treatments

If you take high-dose opioids, other procedures to help your pain are less likely to be successful. Examples are nerve blocks (injections of painkilling medicine around a nerve or group of nerves), joint injections, and pain rehabilitation programmes.

People who are dependent on opioids are less likely to return to work, and more likely to need further medical care.