Guidelines for prescribing opioids for chronic non-malignant pain

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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.


  1. CDC Guideline for Prescribing Opioids for Chronic Pain 2016. Click here
  2. Summary: CDC Guideline for prescribing opioids for chronic pain.  Click here
  3. Medicines optimisation in long-term pain NICE 2017. Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

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    As published in NZ Doctor 04/07/2018