Overview of analgesics for chronic noncancer pain

Analgesics should not be used as the primary management strategy for chronic noncancer pain because they are unlikely to eliminate pain and adverse effects often outweigh benefit, especially in the long term.

If the goals of care are palliative, see Principles of managing pain in palliative care.

When a patient with chronic pain presents with acute pain, assess whether the acute pain is caused by a new pathology (eg acute myocardial infarction, bowel obstruction, trauma) or if it is an exacerbation of chronic pain (ie a flare). See General principles of acute pain management.

Before considering analgesics for chronic noncancer pain, assess the patient to identify the key sociopsychobiomedical contributors to a patient’s pain experience (see Assessing a patient with pain). Regardless of the underlying pathology, if key contributors are managed effectively, analgesics may not be required.

Analgesics should only be used as a part of a multidimensional approach (ie in conjunction with social, psychological and physical management techniques); see Initiating analgesics for chronic noncancer pain. If analgesics are used, often they are only required in the short- to medium-term until a patient has achieved self-management. The goal is to integrate self-management strategies into daily routine and deprescribe analgesics.

Some patients with ongoing underlying pathology (eg spinal cord injury) may benefit from analgesia long term. For patients on long-term analgesia, trial deprescribing every 3 to 6 months. This helps to assess ongoing efficacy attributable to analgesia and reduces the risk of long-term adverse effects, see Reviewing analgesia efficacy for chronic noncancer pain. Dose reduction and discontinuation of analgesics is often possible once self-management approaches have been achieved.

Seek specialist input if analgesics are required for the ongoing management of chronic noncancer pain in children and adolescents.