Conclusion
There is compelling logic to treating pain with analgesics including
using opioids. However, for chronic pain, this logic does not fit with
the evidence which shows that opioids are often ineffective and can
cause significant harm. Most prescribing for long-term conditions is
done by primary care, most consultations about chronic pain are with
GPs, they are often difficult consultations 6, there
is significant time pressure and there is a lack of guidance to support
GPs 5. Developing a shared understanding with the
patient requires sufficient time to discuss complex ideas, it requires
trust, regular follow-up and continuity of care all of which are under
threat from a shortage of doctors, growing demand and the prioritisation
of access over continuity. In many areas, specialist services are not
easily accessible or are not available at all. In the absence of
sufficient resources to meaningfully assess and manage the large number
of patients with chronic pain, pharmacological management including
opiates is likely to remain the default response, deprescribing is
unlikely to be prioritised and the NHS is at risk of a growing opioid
epidemic.