Chronic pain and opioids

What is chronic pain?

Chronic pain (persistent or long-term) is a pain that continues for 3 months or more and may not respond to usual medical treatment. More than a third of the population live with chronic pain. It is a long-term pain that cannot be ‘fixed or cured’.

Pain and the brain – how it really works

Pain is one of our protective systems. It is designed to keep us safe and well, and it’s controlled by the brain. Our brain decides to protect us based on two types of information.

  1. Information it receives from the areas of the body.
  2. Information from elsewhere including pain memories, your mood, past experiences and more.

If the brain needs to protect us, pain will happen.

In persistent pain, even though the original trigger for the pain may have stopped, the other factors are still there. So the brain becomes over-protective and keeps the pain going.

It is a bit like the brain struggling to turn down the ‘volume control’.

Retrain your brain

It can come as a bit of surprise to realise that we can ‘retrain your brain’ to turn the pain down.

The way to do it is by getting fitter and stronger, balancing your activities and focusing more on your goals and less on the pain.

Over time, as you are living a more healthy life, being more active, doing things normally and focusing on living life, your brain will become less overprotective and your pain more manageable.

More information can be found here:

Pain can affect just about every aspect of people’s lives. It can affect:

  • The way people move
  • How much they do
  • How far they go
  • How able they are to take part in activities
  • How confident and optimistic they feel.
  • Relationships with others
  • How well they sleep or concentrate
  • How much they enjoy life.

What can you do to help yourself?

It may not be possible to get rid of all the pain, but it is possible to reduce the ill health and suffering it causes.

1.     Setting goals

Setting goals for each day and for the longer term, can help keep the body and mind active. This also helps give direction to your recovery. In time, these goals can become more challenging but you have to break them down into small and manageable steps

2.     Keeping physically active and eating well

Research shows that people with persistent pain who keep active tend to feel better and can do more. When in persistent pain, movements or activities that can make pain worse do not necessarily involve further damage or injury. Physical activity can increase the level of endorphins (natural pain killers) in our body, reducing pain the natural way. Ask your GP about local exercise on referral schemes.

The following organisations can help you to live a healthy lifestyle, such as stopping smoking, being more physically active and eating healthily:-

 

3.     Psychological support

VitaMinds provide self-guided on line support, group courses for stress and low mood for people with long term conditions and 1 to 1 support. For more information go to their website https://www.vitahealthgroup.co.uk telephone 0333 2001893.

There are three helplines that you can telephone for support:-

  • Pain Concern helpline, on 0300 123 0789, available Monday and Friday, 10am to 12pm and 2pm to 4pm
  • Action on Pain helpline, on 0345 6031593, available Monday to Friday, 10am to 4pm
  • Versus Arthritis helpline, on 08005200520, available Monday to Friday, 9am to 8pm

The opening hours of these helplines may change depending on availability of the volunteers who staff them.

4.     Pacing

Carrying on physical activity to the point of unmanageable pain or exhaustion is rarely helpful. Taking regular breaks in activities, changing position, resting briefly between activities or doing stretches throughout the day can all help.

5.     Relaxation

Practising relaxation techniques regularly can help to reduce persistent pain. Learning to relax can help you sleep, get good quality rest and cope well with stressful and difficult situations. There are many types of relaxation technique and there may be classes available locally that can teach you relaxation, for more information go to www.wellaware.org.uk There are also many books, CDs or videos on relaxation techniques, go to http://www.paincd.org.uk/

6.     Breathing correctly

Stress and pain can lead us to breathe incorrectly, taking short shallow breaths from our chest. This type of breathing can cause unpleasant symptoms such as tension, dizziness, racing heart, difficulties concentrating, chest tightness and pins & needles.

The correct way to breathe is from the tummy not the chest. When you breathe in your tummy should move out a little, when you breathe out, your tummy should fall in slightly. Your upper chest should stay still at all times.

Relaxed, slow breathing from the tummy helps you stay calm and relaxed. A lot of people with pain have said that learning to breathe like this was one of the most important things they learned.

7.     Socialising

Having contact with people can play an enormous part in helping you feel better. Pain can make it hard to get out to see people or to join in with what they are doing, but social contact can be at home, over a cup of tea, within whatever limits you have. It has been shown that keeping in touch with friends and family is good for our overall health.

If you are over 55 and are feeling isolated or lonely you can get support from LinkAge Tel: 0117 3533042 or www.linkagenetwork.org.uk or email linkage@ageukbristol.org.uk

8.     Enjoyment

Sometimes you may concentrate on what you must do and forget the enjoyable activities. Try to find the time to phone a friend or go out to the cinema, even if you have to leave halfway through. Be pleased with the things that you have accomplished. Try to include at least one enjoyable activity in your list of things to do every day. Fun and pleasure stimulate serotonin (known as the happiness hormone) in our body. Raising serotonin levels can reduce pain, improve sleep and our mood.

9.     Distraction

Shift your attention onto something else so the pain isn’t the only thing on your mind. Get stuck into an activity that you enjoy or find stimulating. Many hobbies (like photography, sewing or knitting) are possible even when your mobility is restricted.

10.Medicine

Medicines are often used for persistent pain and may give valuable relief. However the longer the pain goes on for the less useful they become and many of the pain killers that doctors use are addictive. They are just one of the many tools in our ‘toolbox’ and you should use them alongside all of the other tools. The aim should be to use the minimum amount of medicines needed to allow you to increase your general activity and exercise.

Opioids

Co-codamol and tramadol are painkillers from the opioid family. Opioids are very good painkillers for short-term pain after surgery or after an accident (such as a broken bone). This is known as acute pain and lasts days or weeks.

It used to be thought that opioids were also useful for people with longer-lasting pain known as chronic pain which goes on for months or years. We now know that opioids don’t help long-term pain and, more importantly, are not safe to take for longer periods of time. Doing this can cause side effects, addiction or early death.

Side effects of opioids

  • Constipation and nausea (feeling sick)
  • Daytime sleepiness, poor concentration, and poor memory
  • Problems sleeping at night, including snoring or difficulty breathing.
  • Effects on hormones

Such as reduced fertility, low sex drive, irregular periods, difficulty having sex, feeling tired, hot flushes, depression and osteoporosis.

  • Effects on your immune system

This can make it more difficult to fight infection.

  • Opioid-induced hypersensitivity

If you take opioids for a long time, they can start to make you more sensitive to pain. You may notice that something that you’d expect to hurt a bit can feel extremely painful. So, rather than help reduce pain, the opioids start to make your pain system more sensitive. Stopping opioids completely will reverse this effect, so you may find that your pain gets better once you’ve stopped taking opioids.

Tolerance, dependence, and addiction

Tolerance is when opioids become less effective over time, as your body has got used to the pain-relieving effect.

Your body can also become dependent on opioids, so that if you stop taking them suddenly you get symptoms of withdrawal. Occasionally people in pain can become addicted to opioids. You might crave the medicine or carry on taking it even when it has a negative effect on your physical or mental health.

Driving and opioids

Co-codamol and tramadol can affect your ability to drive safely. Driving ability gets even worse if you are also taking other drugs that make you feel sleepy, such as diazepam, amitriptyline, gabapentin and some over the counter medication.

Whatever drugs you are taking, you must never drive if you don’t feel safe to do so.

Your medication

Reducing your medication slowly will help reduce the chance of you developing feelings of withdrawal or, if you do, they will be mild.

You may find you are more irritable than usual or may feel more anxious or depressed. If this becomes a problem, speak with your GP about Talking Therapies or changes to your other medication.

As you reduce your opioids you may experience withdrawal symptoms, such as feeling shivery or sweaty, diarrhoea, or stomach cramps. Occasionally pain ay worsen for a short while.

These symptoms shouldn’t last long, and we suggest that you use distraction or relaxation techniques to help during this time. Music, books or films can be useful for distraction, as well as getting out and keeping active, even if it is just walking.

Having nice snacks or drinks may help, if you lose your appetite and can stop you from becoming dehydrated.

The most important thing you will need is support from family and friends, who should understand that this is an important but possibly difficult thing for you to do. Even after you stop all your opioids it can take 4-6 months to feel back to normal, so you will still need their support during this time.

Health Care Professionals supporting you such as your GP, Practice based Pharmacist, Nurse or Social Prescriber can discuss long term pain management strategies with you, including self-care resources.