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Guidelines for prescribing opioids for chronic non-malignant pain

Non-opiates and non-pharmacological therapy are first line treatment for chronic non-malignant pain (CNMP).1 There is a useful two page CDC summary2 and a NICE guideline.3

  • Good CNMP management includes psychological therapy. Pharmacological therapy has poor evidence beyond the acute pain management stages.
  • Opioids are rarely first-line or routine therapy for CNMP.
  • Before starting opioids check expectations for pain and function, and zero pain is not the goal. Check for history of all drug dependence or intoxication.
  • Start with short acting first.
  • Extreme caution when going above ≥ 50 morphine milligram equivalents/day.
  •  Long term use often starts with acute pain so prescribe the lowest effective dose of short acting – 3 days or less will often be sufficient and more than 7 days rarely needed.
  • There is no particular advantage for oxycodone over morphine.

This Gem has been checked by Dr Linda Bryant, Clinical Pharmacist.

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