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Prescribing drugs of dependence in general practice

Part C2 - The role of opioids in pain management

A summary of opioid prescribing in general practice

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Last revised: 02 Jun 2020

Acute pain is an unpleasant sensory and emotional experience usually related to surgery, injury or disease. It is associated with actual or potential tissue damage to non-neural tissue and is experienced due to activation of nociceptors. This is also known as nociceptive pain.

Acute pain includes inflammatory pain; that is, pain that occurs in response to tissue injury and the subsequent inflammatory response. Typically, inflammatory pain disappears after resolution of the initial tissue injury. However, in chronic disorders (eg rheumatoid arthritis) the pain may persist for as long as inflammation is active.

Effective management of acute pain requires:

  • tailoring treatment to the individual patient
  • awareness of the science behind contextual and placebo effects
  • competence with multimodal analgesia (ie the concurrent use of different classes of analgesics)
  • providing patient reassurance
  • providing education, including expected duration of pain episode and warning signs that would require immediate medical attention.

For accountable prescribing in managing acute pain, GPs should

  • undertake a complete biopsychosocial assessment of the patient with pain
  • be familiar with the evidence for selected acute pain presentations in general practice where opioids are not routinely recommended
  • prescribe opioid medications only for the treatment of acute nociceptive pain when non-opioid pain medications and therapies have failed or are likely to fail
  • undertake a patient selection/exclusion process before commencing opioids.

If opioids are commenced for the pain of acute nociception, there is a need to give clear direction about the anticipated duration of therapy. Typically, opioids should be weaned and ceased as the acute injury heals. Usually three days or less of opioid therapy will be sufficient for non-traumatic pain not related to major surgery. Even in complex postoperative cases, this should be within 90 days.5

GPs need to be familiar with the complexities of care in patients on long-term opioid therapy who present with an acute exacerbation or new acute pain.

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