Start from a place of empathy and focus on supporting quality of life improvements as identified by your patient. Explore their pain and its functional impacts, discuss the role of opioids and the newer evidence-based interventions that do not involve medication for management of chronic non-cancer pain5.
Monitor the patient’s pain and tailor a plan with the patient that is collaborative. This may involve a slow and well supported weaning schedule. For resistant patients, consider their dependence and assess for possible co-existing opioid use disorder using the DSM-5 criteria for diagnosing an SUD. Consider and discuss whether opioid replacement/substitution therapy may offer better treatment.
In recent years, many helpful resources have been developed to support GPs to discuss chronic persistent non-cancer pain with patients. To access videos, articles, toolkits, and patient resources such as animated videos and handouts, access the Chronic non-cancer pain resources.