1: Treatment options before considering opioids in chronic
non-cancer pain |
| Medication |
- Simple analgesics
- Non-steroidal anti-inflammatory drugs
- Tricyclic antidepressant drugs
- Membrane stabilisers |
Exercise programs
Transcutaneous electrical nerve stimulation
| Psychological therapy |
- Relaxation
- Cognitive behavioural therapy
- Hypnosis
- Coping strategies |
Invasive procedures (e.g., spinal injections, neuromodulation)
Multidisciplinary pain management programs
Questions for the doctor before prescribing opioids
- Has the patient tried opioids for this condition before?
- Is the diagnosis established? If not, are further investigations
required?
- Does the patient have neuropathic (nerve damage) pain? If so, have
non-opioids, membrane stabilisers and antidepressants been tried?
- Has the patient had a reasonable trial of non-drug treatments,
including assessment and treatment of psychosocial factors
contributing to pain behaviour?
- Is the patient well known to you and psychologically stable?
- Does the patient have a history of previous drug, alcohol or
substance abuse?
- Does the patient understand the implications of long term opioid
therapy? Is written consent necessary?
- Do I have the back-up resources if required?
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© 1997 Medical Journal of Australia.
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