ABSTRACT
Chronic pain is understood not just to be a symptomatic element of other more identifiable morbidities, but a defined condition in its own right. Prior to 1986 stigma surrounding the prescription and taking of opioids meant that people often suffered unnecessarily and died in pain. Then came the World Health Organisation analgesic ladder, an easy-to-follow model advocating the introduction and incremental titration of analgesics, dosed ever upwards as required to relieve the burden of terminal cancer pain. The resulting mercy of comfortable effective palliation legitimised opioid use and set the scene for the moral imperative of pain control to extend to the issue of chronic pain. Research, however, has since shown these tools to be unsuited and lacking in consistent good quality evidence for use with these complex and sometimes lifelong problems.
This chapter explores further:
UK guidance on prescription of opioids for chronic pain management.
The experience of pain and associated factors; understanding that pain itself is complex, with deeply entrenched variables and underlying mechanisms across biological, psychological, emotional and social dimensions.
The adverse effects of drug-drug and drug-disease interaction and the correlation of opioid-related harm with dose and continued use.
Pain medication and management including suggestions for practice.
