you can also consider constant rotation of pain relief in order to prevent a system dependency. In the UK we do have a lot of patients on MST (morphine) and oromorph, and these are routinely either rotated to compensate OR are changed for Tramacet (tramadol) or naproxen,gabapentin or something else. codine is routinely used also. I hope this helps.

in the ambulance service it is a little different but we tend to use morphine in a step approach

paracetamol/ibruprofen--->Entonox----> penthrox (where used)---->codine(where used)--->morphine

Its important to know what is causing the chronic pain.

As a pharmacist and trained medical herbalist I use different approaches which include recommending physiotherapy and acupuncture.

There are some herbal pain relievers that can be used including Devil's claw- Harpagophutum procubens as well muscle relaxant herbs. Depending on the site of the pain, the leaf of the plant Moringa citrifolia applied topically provides excellent pain relief; studies show that the plant has both COX1 and COX 2 effects. If the client is not on medicines that would interact with St. Johns wort I also advise the use this herb because it somehow eases the pain.

Cannabinoids offer excellent pain relief but are illegal in some countries so depending on where the patient lives these may be an option. Creams containing cayenne applied locally are also beneficial

Neuropathic pain usually responds well to amitriptyline, gabapentin, carbamazepine and such drugs. Paracetamol + diazepam is also an option as well as Tizanidine if the pain related to muscular tension

Fazleh Mahomed , I could not agree with you more,however,I believe in different strokes for different folks .Different pin thresholds as well.o monitoring i key and this can be done through rigorous review of patients put on any pain relieve medication. This would help reduce unnecessary intake without compromising the real need for pain relieve medication.

So the BIG question is: how to treat chronic pain conditions effectively, without causing addiction?

Dear Fazleh,

Chronic pain is a very broad term where it could be malignant chronic pain(related to cancer and AIDS) and non-malignant chronic pain(which can be neuropathic, inflammatory, nociceptive..etc). Hence, pain management plan varies widely based on the pain type; e.g: neuropathic pain is more likely to benefit from gabapentin or pregabalin but not opioids.

Concerns about addiction could be minimized through different strategies as recommended by the guidelines (for example: opioid rotation, relying more on sustained release formulation rather than the immediate release, as well as continuous follow up). Fear of addiction should not lead to improper pain control in this population. Moreover, there are some tools that can assist the physician to predict those patients who have higher risks.

you may have a look at:

Opioid Treatment Guidelines

Clinical Guidelines for the Use of Chronic Opioid Therapy

in Chronic Noncancer Pain

Article Clinical Guidelines for the Use of Chronic Opioid Therapy in...

Regards.