Case of the Month #8: Longstanding pain and opioid use

Published: 05/10/2021

Management Plan

The MDT formulated a plan, involving the patient in the decision-making process. She agreed to further follow up sessions to support her to reduce her reliance on medication. This involved the team sharing their understanding of the side effects and potential harms of opioids and she agreed to reduce both her long acting and short acting opioid preparations very gradually over several months. She was then invited to attend the service’s pain management programme, which included education, exercise, pacing and Acceptance and Commitment Therapy (ACT)-based psychology sessions. At follow up at six months, she had stopped her morphine completely, although remained on a p.r.n. dose of co-codamol. She is now keen to reduce her gabapentin too. She has achieved some of her goals: she meets a friend regularly socially and has even started going to a local gardening club. Her pain remains but she feels much better in herself and her battle with pain is no longer the ever-present focus in her life. She reports she feels more like her old self now she is off morphine. She is less worried about the future and admits she can now look forward to holidays. She still gets bad days, which leave her feeling frustrated and isolated. But they are less frequent.