Opioid medicines can be used to reduce some types of pain, such as acute pain and chronic pain caused by cancer. However, their role in the management of chronic (non-cancer) pain is limited. Pharmaceutical opioids include naturally derived opioids (codeine, morphine and oxycodone), methadone, synthetic opioids (pethidine, fentanyl, tramadol) and other/unspecified opioids.
Evidence suggests that harmful effects are more likely to happen to people who take opioids for 3 months or more, or who take higher doses of opioids. The harms from opioids can range from mild to severe and can end up causing death. In fact, every day in Australia there are 3 deaths, 150 hospitalisations and 14 emergency department presentations from opioids.1
Evidence shows that the longer someone takes an opioid, the less pain relief they have. This is because the brain gets used to that opioid dose. This effect is known as tolerance and can lead a person to take higher doses or more types of opioids in order to get the same pain relief.
Dependence is different from tolerance. When someone is dependent on their opioid medicine, they will experience withdrawal symptoms if the opioid dose is reduced or stopped. Dependence can occur within one month of starting to take an opioid.
For some people, the main reason they continue to take opioids long-term is to avoid withdrawal symptoms, although they may not realise this. They mistakenly think the opioid is working to reduce pain, when in fact it’s only reducing withdrawal symptoms, which can include pain.
Opioid Alternatives
Medical experts recommend that people living with chronic (non-cancer) pain should first try to manage pain using combinations of treatments and medicines that include:
- learning about why and how chronic pain happens
- self-management approaches (such as sleep routines, hot/cold therapies)
- gradually increasing physical activity (sometimes called graded activity)
- psychological treatments such as cognitive behavioural therapy (CBT)
- the use of certain pain relief medicines such as paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)
These treatments are recommended because they can be effective and safe, particularly when done in combination
Examples of non-pharmacological therapies for chronic (non-cancer) pain
(Source: NPS Medcinewise: https://www.nps.org.au/news/if-not-opioids-then-what)
Active physical therapies and techniques
- general strengthening and gentle aerobic exercise (graded up slowly) eg, planned daily walks of gradually increasing distance
- hydrotherapy
- physiotherapy
- occupational therapy
- tai chi
- yoga
Psychological therapies
- acceptance commitment therapy (ACT)
- attentional techniques (distraction from the pain)
- biofeedback
- cognitive behavioural therapy (CBT) on a one-to-one basis or in a group
- counselling
- mindfulness-based stress reduction (MBSR)
- relaxation training
Other treatment options
- activity pacing to regulate activity levels of everyday tasks eg, light housework, walking the dog
- acupuncture
- attending a group pain management program
If you are currently take opioids and would like to take a different approach, read the information below under Sources and Further Reading and talk to your doctor as a first step. You can also call NPS Medcinewise for advice on 1300 134 237.
Sources and Further Reading
- The Arthritis Movement: Managing Chronic Pain
- NPS MedicineWise, Opioid medicines and chronic non-cancer pain
- NPS MedicineWise, Chronic pain explained
- NPS Medicinewise, If not Opioids, then what?
- ACI NSW Pain management network, Pain management: For everyone
- ACI NSW Pain management network, Pain and thoughts. A video about how negative thoughts and stressful life situations can influence pain.
- Hunter New England Local Health District, Understanding pain in less than 5 minutes, and what to do about it! A video that summarises the difference between acute and chronic pain.
- Pain Australia, List of pain services in Australia
- PainHealth, Pacing and goal setting
Information provided is of a general educational nature only and should not be relied upon as medical advice. Consult your health care professional about the treatment that is best for your particular case.
