Can chronic pain be managed without prescription medication? In Australia, many doctors are having to have difficult conversations with patients after the Federal government’s recent decision to make medicines containing codeine available on prescription only. These people are now forced to either find a new medication, or some alternative to medication, or have to visit their doctor more often to get prescriptions.
The decision has prompted New Zealand to consider following Australia’s lead and earlier this year it was reported that Medsafe’s Medicines Classification Committee recommends medicines such as flu tablets and painkillers that contain codeine, which is an opiate, become prescription only here from January 2020.
Living with chronic pain is one of the most common reasons people have to see their doctor or other health professionals, so there are a lot of very reasonable questions for us to answer.
What’s the difference between acute pain and chronic pain?
The definition of acute or chronic pain is not about how severe the pain is. It is about the timing. Acute pain is recent in onset. Chronic pain is pain that has become long term, usually for more than about six months.
For acute pain, the emphasis is generally on removing the pain by identifying the cause and providing pain relief while your body heals. In many chronic pain conditions, we may not be able to identify the underlying cause of the pain with certainty, or the cause may not be treatable.
Pain starts with damage to body tissues. Then a number of secondary changes in the brain and the nerves in the body amplify the pain experience. So the treatment of pain often needs to address these secondary changes as well as the origin of the pain.
What are my options?
Have a case review with your GP.
Was the original diagnosis of your condition correct? Have you had all of the appropriate imaging, such as ultrasounds or MRI scans, to confirm your condition? Is there anything else that can be done to treat the origin of the pain?
Depending on the type of pain you have, a second opinion may be reasonable. There are specialised pain clinics in some major public hospitals where your condition and treatment plan can be reassessed. You will need a referral from your GP.
What non-pharmaceutical pain management options can I try?
There are many treatments and techniques that you can use to help eliminate pain and/or reduce its effect on your quality of life. You may need to trial a few different techniques or combinations to figure out what works best for you. Here are some of the most popular:
Psychological techniques: cognitive behavioural therapy, relaxation techniques, guided imagery
Physical and manual therapies: physiotherapy, osteopathy
Exercise techniques: yoga, Tai Chi, supervised rehabilitation, hydrotherapy
Relaxation techniques: meditation and mindfulness
Music therapy
Art therapy
Acupuncture
Low-level laser treatment
Affordability is a real issue for a lot of people, as there is usually an out-of-pocket cost for services in the private sector. Some treatments will be available in public hospital clinics and other treatments outside of the public system may be subsidised.
These might include acupuncture, physiotherapy, osteopathy, psychology and exercise physiology.
When should I seek further medical attention and prescription medicine to deal with pain?
If your pain is not well controlled you need to keep trying to find solutions. Consider all aspects of your experience of pain, whether physical, psychological or spiritual, and what it means to your quality of life.
Could it be “all in my head”?
In a word, no. Pain actually caused by psychological issues is extremely rare.
Psychological factors do contribute to the intensity and quality of your pain experience, as well as the way you behave because of your pain. Mood problems such as anger, frustration, anxiety and depression are also very common consequences of pain.
You will manage your pain better if you include psychological techniques in your treatment plan, regardless of the cause. Your family and friends need to understand your condition and what you need to do to feel better.
My advice
Review your pain-management plan regularly.
Find interests and activities you are able to do.
If a medication is prescribed temporarily for a specific purpose, ask your doctor to provide you with a programme for reducing and ceasing the medication within a reasonable time.
If you are prescribed opioid analgesics, ask if there are less addictive options.
Non-steroidal anti-inflammatory drugs (NSAIDs) should be used at the lowest possible dose for the shortest possible duration because of potential side effects.
