Key points

Key points

  • Controlling chronic pain can present significant challenges.

  • It is unusual for any analgesic, including strong analgesics like opioids, to completely eliminate chronic pain. The focus of treatment should be on reducing a person's pain with a view to improving their quality of life.

  • Using the World Health Organization (WHO) analgesic ladder in people with chronic pain, without taking into account the complexity of the person's individual needs, preferences for treatments, health priorities and lifestyle, may contribute to inappropriate prescribing.

  • The use of opioid and non-opioid analgesics, especially gabapentin and pregabalin, can be associated with serious harms and can lead to dependence; these medicines may also be misused or diverted to illegal use.

  • Pregabalin and gabapentin were reclassified as class C controlled substances in April 2019, and placed under Schedule 3 of the 2001 Misuse of Drugs Regulations but without the safe custody requirements.

  • Options for local implementation:

    • Ensure people with chronic pain receive optimal pain treatment with careful consideration of the benefits and risks of treatment options.

    • Be familiar with the range of non-pharmacological interventions that are effective for reducing symptoms and disability in people with chronic pain and the local availability of these services.

    • Assess risk and address harms of medicines where safety issues are a concern, such as opioids, gabapentin and pregabalin.

    • Review and, if appropriate, optimise prescribing of opioids, gabapentin or pregabalin to ensure that it is in line with national guidance.