General considerations for the management of pain with any medication that contains an opioid mechanism of action

The following general aspects should be considered:

An individualised, patient-centred approach for diagnosis and treatment of pain is essential to establish a therapeutic alliance between patient and clinician.
Consider patient variables that may affect opioid dose in patients prior to opioid use.¹
In patients with acute pain e.g. post-surgery pain, the use of medication should be for the shortest necessary time.¹
All patients should be carefully selected, abuse risk factors evaluated and regular monitoring and follow-up implemented to ensure that opioids are used appropriately^3,4and in alignment with treatment goals (pain intensity and functionality) as agreed with the patient.^3,4
Patients should be made aware of the potential side effects of opioids and the potential of developing tolerance, dependence and addiction.^3,4
It is important to optimally use multimodal, non-opioid approaches in acute and chronic pain before escalating to opioids or in conjunction with opioid therapy.¹
Addiction is possible even when opioids are taken as directed. The exact prevalence of abuse in patients treated with opioids for chronic pain is difficult to determine.⁵
Regular clinical reviews are required for long-term opioid treatment to assess pain control, impact on lifestyle, physical and psychological wellbeing, side effects and continued need for treatment²
Any long term treatment with opioids should be monitored and re-evaluated regularly, including tapering down the dose or discontinuing treatment^3,4
Signs of opioid use disorder should be monitored and addressed^3,4
Patients and the general public can benefit from clear educational materials and awareness interventions to support the responsible use of opioids.⁶

References

^1.DHHS Pain Management Best Practices Inter-Agency Taskforce Report May 2019.
^2.O’Brien T et al. Eur J Pain 2017;21:3-192.
^3.Faculty of Pain Medicine, Opioids Aware. Available at: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware (accessed September 2019).
^4.Kosten TR et al, Scie Pract. Perspect 2002;1:13-20.
^5.Rosenblum A et al Exp. Clin. Psychopharmacol. 2008;16(5):405-416.
^6.OECD Health Policy. Addressing Problematic opioid use in OECD Countries May 2019. Available at: http://www.oecd.org/health/addressing-problematic-opioid-use-in-oecd-countries-a18286f0-en.htm (accessed January 2020).

M-N/A-UK-04-20-0010 April 2020