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

Published: 05/10/2021


A 53-year-old female was referred to the outpatient pain service with persistent spinal and multiple site joint pain. She had been taking a variety of prescription analgesics for years and her pain was now more widespread. Her locum GP was concerned about her repeat prescription requests for liquid oral morphine.

The patient completed a pre-appointment pain service questionnaire, which included a range of psychometric scores, and she was assessed at her initial appointment by a multidisciplinary team, comprising a pain consultant, a physiotherapist and a clinical psychologist. 

She first experienced low back pain in her role as a domestic cleaner 30 years earlier, pain which had gradually increased in severity. Over the years, she developed more extensive pain, affecting her entire spine and other areas of her body including her hips, knees and shoulders. She had previously consulted a range of health care professionals including GPs, rheumatologists, surgeons and chiropractors. She explained she understood she had degenerate lumbar discs and was ‘riddled’ with arthritis in her joints. 

She was taking a combination of regular co-codamol 30/50, prolonged release morphine 50mg b.d., as well as gabapentin 600mg t.d.s. and she was also prescribed 10mg liquid morphine p.r.n. She explained how she took a ‘swig’ of the liquid morphine before bed and during regular exacerbations of pain during the day, which she described as her ‘breakthrough’ pain. She felt it did not work and she now wanted something else to try to achieve pain relief

  • Is there any other information you would like to know? 
  • What do you think about her understanding of persistent pain? 
  • How might you manage her expectations?
  • What management options might be useful?