Chronic pain management

Question 1

What are non-pharmacological methods of managing chronic pain?

Answer 1

-Exercise programmes, increasing physical activity
-Psychological therapy (ACT, CBT)
-Acupuncture
-Electrical physical modalities eg TENS, US, interferential therapy

Question 2

What are pharmacological methods of managing chronic pain?

Answer 2

-Antidepressants eg amitriptyline, citalopram, sertraline, fluoxetine (>18s)
-Explain that further benefits including improved sleep, quality of life, and reduced psychological stress may occur even in the absence of depression

Question 3

What medicines are not recommended / should be stopped in patients with chronic pain?

Answer 3

-Gabapentinoids
-Antipsychotics
-Benzos
-Ketamine
-Local anaesthetics
-NSAIDs
-Opioids
-Paracetamol