Prescribing drugs of dependence in general practice, Part C2: The role of opioids in pain management

Introduction
Pain is a common general practice presentation and pain management is a fundamental general practitioner (GP) role. An estimated 20–40% of patient presentations involve chronic pain, which makes it the most prevalent
condition managed in general practice.2,3 Almost 10% of this pain is measured at Grade IV (the highest level of severity using Von Korff’s pain scale). This level of pain is highly disabling and severely limiting.
Bettering the Evaluation and Care of Health (BEACH) data revealed that most of the chronic pain seen in general practice is musculoskeletal (of that, 48% is osteoarthritis and 28% low back pain). However, one in five chronic
pain presentations is neurological (of that, 20% is peripheral neuropathy).
Opioids are important in the management of pain and are highly beneficial to some individuals. However, there are increasing community concerns regarding their use and safety. GPs need to be aware of the broad issues around opioid use in society, as well as specific problems at a patient level, and how to address these issues with evidence-based interventions.
Aims
This guide is a resource designed to assist with the appropriate and accountable prescribing of analgesic medications in the general practice context. Used in combination with Prescribing drugs of dependence in general
practice, Part C1: Opioids, it is designed to discourage inappropriate use and reduce harms of opioids. It provides GPs with evidence-based guidance and practical advice regarding pain and pain management. In particular, this
guide provides recommendations for GPs who are prescribing opioids for acute and chronic pain outside of active cancer treatment, palliative care, and end-of-life care.
Scope
The guide specifically relates to general practice patients (18 years and older) who have acute pain and CNCP. It covers:
• pain – the experience, classifications and assessment
• pain management – non-drug and drug therapies
• the place of opioids (and other interventions) in pain management in general practice
• the evidence-based recommendations for opioid prescribing in general practice, particularly regarding CNCP,
including
– when to initiate, continue and discontinue opioids for chronic pain
– which opioids to select (with dosage, duration, follow-up and discontinuation)
– how to assess risk and address harms of opioid use
• the options for opioid tapering and withdrawal in general practice.
Implementing principles from this guide should facilitate improved patient care and reduce the risk that GPs will be involved in an adverse event associated with prescribing opioids.
This document does not examine opioid use in cancer-related pain, palliative care or end-of-life care, nor does it address use of opioids in the management of opioid dependence.