Opioids to treat long-lasting pain

What are opioids?

Opioids are powerful prescription-only drugs such as morphine and other drugs that produce morphine-like effects.

When are opioids prescribed?

Opioids are used to treat severe short-term pain in certain circumstances, such as the first few days after an operation, and long-term (chronic) pain caused by cancer.

Can opioids reduce long-term pain that is not caused by cancer?

Because opioids can help reduce short-term pain and cancer pain, some people think opioids will reduce their long-term pain, but unfortunately this is not right.¹

If you do take opioids for long-term non-cancer pain, you might see a small improvement in your ability to do some day-to-day tasks, but the improvement is small and will be temporary, and there are many potential harms from taking opioids that outweigh the benefits.²

What are the harms of taking opioids?

Taking opioids can result in harms that range from mild (eg drowsiness and constipation) to severe and can result in hospitalisation and, sometimes, death.^1,3

In addition, the longer you take opioids, the less pain relief you actually experience, because your brain gets used to the dose (this is known as ‘tolerance’). Taking opioids can even increase your pain because opioids can make your nerves and your brain more sensitive to pain.¹ This is a condition called ‘opioid-induced hyperalgesia’.

• If you stop taking opioids suddenly, you can also experience unpleasant withdrawal symptoms.

Taking even small quantities of opioids comes with risks, especially if you have long-term non-cancer pain.

Opioids are usually not effective in controlling long-term painful conditions (with the exception of cancer pain) and will not increase your quality of life or improve your ability to participate in activities that are important to you.

In addition, you may be at increased risk if you are also taking substances (eg alcohol and other drugs) that can make you sleepy.

Your doctor’s legal obligations

Because of the high risk of harm caused by opioids, doctors must follow laws that require them to prescribe responsibly. This includes limiting the amount and type of opioid they prescribe for a patient, and being aware of the details of any previous opioid prescriptions a patient may have had (eg the date the prescription was filled, what type of opioid and the dose).

Before prescribing opioids, a doctor must also know your full medical history, including your mental health and medications you are taking. This may involve checking on your recent prescriptions and when you had them filled, and asking you to take a urinary drug test.

If your GP prescribes opioids for your non-cancer pain, they will explain that you cannot go to another prescriber for opioids, and may arrange regular reviews to check on your progress and your reaction to the medications.

When would a GP prescribe opioids for my pain?

Your GP will prescribe opioids for you only if they:

• have conducted a thorough medical assessment of your current health
• have had a detailed discussion with you about your pain and treatment options
• believe it is the right drug for your pain.

Depending on your circumstances, they may start you on a short-term trial of a low dose of opioid medication, along with some other non-drug strategies to help you manage your pain.

What should I expect if a GP prescribes me opioids?

Depending on your circumstances, your GP may start you on a short-term trial of a low dose of opioid medication, along with some other non-drug strategies to help you manage your pain.

What happens after I have been prescribed opioids?

Your GP will probably schedule regular reviews to see how effective the treatment has been and whether you have experienced any side effects. At each review, your GP may use a pain scale or questionnaire to determine any improvement in your function, and ask you about how well you are participating in daily activities.

What are my responsibilities if my GP has prescribed opioids for me?

• Do not ask another GP to prescribe you opioids.
• Do not change GPs, unless it is absolutely necessary.
• Keep your opioids in a safe place away from children.
• Do not give your opioids to anyone else.
• Return unwanted medicines to your pharmacy for safe disposal.

What are the common side effects of opioid medications?

• Feeling sick and/or vomiting
• Constipation
• Sleepiness
• Itchy skin
• Dry mouth
• Confusion

What should I do if opioids do not help my pain?

• Tell your GP so that together you can work out other ways for you to manage your pain and participate in daily activities.
• Consider using non-drug strategies, such as regular physiotherapy, exercise and psychological support. Or, if you are already doing some of these, discuss other options with your GP, which might include changing or increasing these strategies.

From your GP

• Your GP may give you some information and talk to you about what pain is and how the brain perceives pain, so that you can adopt some self-management strategies that may help to reduce your pain.
• Your GP might suggest medication that is not an opioid.

Physical activity

• Try to participate in regular physical activity, because this can reduce your pain and improve your function and wellbeing.
• If the pain has prevented you from working, return to work as soon as possible (where appropriate), because this will help improve your wellbeing and long-term outcomes.¹
• Consider joining support groups and participating in group activities.

Other health professionals

• Consider psychological therapies with a psychologist, such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT), because these can help reduce your experience of pain.
• Consider seeing an allied health professional, such as a physiotherapist, occupational therapist or exercise physiologist, or attending a pain clinic.​

• Arthritis Australia, Dealing with pain
• NPS MedicineWise, Opioid medicines and chronic non-cancer pain
• NSW Government Agency for Clinical Innovation, self-management of pain resources
• Pain Australia, The nature and science of pain
• Pain Australia support groups and help lines
• University of South Australia, Professor Lorimer Moseley discusses his experience with pain for Feeling Human at MOD