Acute pain is the body's normal response to tissue damage.
Many types of cancer pain are also related to tissue damage or nerve compression.
Persistent non-cancer pain serves no physiological purpose and is influenced not only by tissue injury but by a number of emotional, social and cognitive variables.
Medicines are generally less effective for persistent pain than for other types of pain. When medicines are prescribed, they should be used in combination with other treatment approaches to support improved physical, psychological and social functioning.
Initial prescribing of opioid medicines for pain should be considered for a trial period, with outcomes of treatment (pain and function) agreed with the patient.
If, at the end of the trial, agreed outcomes have not been achieved or progress made towards them, then the patient and prescriber need to discuss whether to continue treatment.
Side effects are relatively common – consider adjuvant drugs such as laxatives and anti-sickness medications if needed. Side effects need to be considered and balanced with potential benefits. If patients continue to take medicines that provide limited analgesic benefit, then they are exposed to harms unbalanced by the benefit that the medicines provide. When medicines do not give sufficient analgesia there is a risk of dose escalation. This is rarely helpful.
