Pain is a big problem and persistent pain can affect 1 in 5 people. Over time there have been many important discoveries that help explained what causes persistent pain, new tretment approaches that are more effective in helping people. Sadly these discoveries are not accessible to patients as most of it is provided in scientific journals. We have collated information below as a resource to develop knowledge about pain and how people can best manage it.

Understanding pain in less than 5 mins (YouTube video)

Understanding Pain in less than 5 minutes, and what to do about it! - YouTube

Why does my GP want to reduce my pain killers?

Why does my GP want to reduce my pain killes

Read patient information about pain killers and follow Opioids Aware to access more trusted resources.

Opioids Side Effect Lottery

Layout 1 (livewellwithpain.co.uk)

Live Well with Pain website (includes patient Ten Footsteps programme and advice about pacing, sleep etc)

Home - Live Well with Pain

Solent MSK (for exercise/stretching/Tai chi videos and mindfulness guidance)

Persistent Pain Management | MSK Solent

10 ways to reduce pain (NHS Information)

https://www.nhs.uk/live-well/pain/10-ways-to-ease-pain/ 

Wider patient education resources

Retraine Pain - a useful collection of useful writen and visual resources about pain - independent and up to date information about pain rehabilitation. Scroll down on main page to watch short clips to learn more about pain and its effect on our lives.

This resource has been adapted from NHS Great Yarmouth and Waverney CCG and Southampton City CCG with kind permission. This document was reviewed by the Wessex Opioid working group in April 2023.

If you are in pain, you may feel that th  idea of reducing and stopping pain killers doesn’t make sense. This  information will help to explain why it may be  beneficial. We are referring to opioid painkillers used for long-term, non-cancer pain

What  are  opioids?

Opioid  drugs  include:

• Buprenorphinepatches  (e.g.,  Butrans®,  Butec®,  Reletrans®,  Sevodyne®)
• Codeine(e.g.,  co-codamol,  Zapain®, Solpadol®)
• Dihydrocodeine(e.g., co-dydramol®, DHC  Continus®)
• Fentanylpatches  (e.g.,  Mezolar®,  Fencino®,  Matrifen®,  Durogesic®)
• Morphine(e.g.,  Zomorph®,  MST®,  Sevredol®,  Oramorph®)
• Oxycodone(e.g.,  Longtec®,  Shortec®,  Oxycontin®,  Oxynorm®)
• Tramadol(e.g.,  Zydol®,  Tramulief®,  Zamadol®)

 10  reasons  why  reducing  opioids  might  be  beneficial  for  me.

1. Recent evidence  shows  little  benefit  of  opioids  when  used  long  term  for  pain.  They  are  not actually  very  effective  when  taken  for  more  than  a  few  months.
2. Patients taking  opioids  for  pain  have  been  compared  with  patients  with  pain  who  are  not  taking  opioids.  The  patients  taking  opioids  tend  to  have  more  pain,  a  worse  quality  of  life and  more  problems  due  to  side  effects.
3. Everyone who  takes  opioids  long  term  will  become  tolerant  to  them.  This  means  that higher  doses  are  required  for  the  same  effect.  If  you  think  your  opioid  must  be  working because  your  pain  increases  when  you  miss  a  dose,  you  may  in  fact  be  experiencing withdrawal  symptoms.  Often  pain  is  no  worse  after  a  slow  reduction  and  eventually stopping  opioids  –  sometimes  it  is  improved.  Lowering  the  dose  is  likely  to  make  you  feel better  in  yourself  too.
4. Reducing opioids  may  reduce  pain.  This  is  more  common  when  very  high  doses  of  opioids have  been  taken  as  they  can  damage  the  pain  nerves,  making  them  too  sensitive.
5. Opioids can  cause  constipation,  abdominal  pain,  weight  gain,  itchy  skin  and  difficulty breathing  at  night.  It  may  be  more  difficult  to  think  clearly  when  taking  opioids.
6. Opioids can  affect  your  hormones  which  can  result  in  you  feeling  miserable  and  tired  or can  lead  to  reduced  sexual  drive  and  infertility.
7. Opioids increase  the  risk  of  falls  and  fractures  by  over  a  third.
8. Taking opioids  for  many  years  can  affect  your  ability  to  fight  infection.
9. Opioids can  affect  your  ability  to  drive.  It  is  against  the  law  to  drive  if  your  ability  isimpaired,  even  if  this  is  due  to  prescribed  medication. If  in  doubt,  you  should  not  drive. See https://www.gov.uk/drug-driving-law 
10. Opioids are  linked  with  an  increased  risk  of  death,  particularly  at  high  doses  and  when combined  with  some  other  medications  such  as  benzodiazepines  (e.g.  diazepam, temazepam),  zopiclone  and  /  or  alcohol.

How can I reduce my opioids?

Discuss a tapering programme with your healthcare professional.

Slow, gradual reductions are needed to reduce withdrawal symptoms from the opioids. Your dose  may be reduced by 10% every 1-2 weeks. A slower reduction may be more suitable for some people, especiall  if you have been taking opioids for several years. Do not stop your opioids suddenly as this will result in more severe withdrawal  symptoms.

Ask for support from your family and friends.

Self-management.

Ideas to help you to look after your own health and wellbeing are available on the internet. These can help with understanding and managing your pain: 

• The Retrain Pain Foundation: 8 lessons on understanding pain (one minute each)
• UnderstandingPain: Brainman Stops His Opioids 
• My Live Well With Pain: Ten Footsteps (other useful videos and resources about pain self- management also  available on this website)
• Opioid Side effects Information Leaflet

What should I expect?

• You may experience increased pain to start with. This might be the same pain you are being treated for or might be general joint and  muscle  aches. This is a withdrawal symptom and should settle within a few days. Make a plan to deal with this, for example distraction, activity, stretching,  mindfulness, heat.
• Other withdrawal symptoms can be flu-like, for example, sweats, chills and headache. Diarrhoea, fatigue, anxiety and sleep disturbance can also occur. 
• Withdrawal symptoms can be reduced by slowing the tapering rate or holding the dose. Ensure you discuss this with your GP or healthcare professional and agree a plan to pause or reduce the taper rate. 
• Do not take a higher dose of opioid once tapering has started. This may be dangerous as your tolerance of the opioid will be reduced  making you at risk of overdose.
• Make sure you are reviewed by the same GP or healthcare professional each time (either by telephone or by attending the surgery) so they can provide you with continued support with your dose reductions.
• It is ok to take a break in the tapering but try to continue to move forward after the pause.

Remember that the long term goal is improved pain control and better quality of life while reducing potential harms of treatment.

Fibromyalgia is a long-term condition that causes pain and tenderness all over your body. Unlike arthritis, this isn’t because you have problems with your joints, bones or muscles. It’s thought to be caused by your nervous system in your brain and spine not being able to control or process pain signals from other parts of your body. The condition is also linked to:

• poor sleep
• feeling you can’t concentrate or remember things
• extreme and constant tiredness that doesn’t improve with sleep or rest – which is known as fatigue.

There can be many other symptoms that affect different parts of your body.

We have pulled together resources to help learn about the condition and improve your wellbeing

Versus Arthritis - provides useful resource to learn about Fibromyalgia, its symptoms and what you can do to help improve your symptoms.

On line course on managing fibromyalgia 

If you are experiencing anxiety/depression with Fibromyalgia: Steps2 Wellbeing specifically the Body and Mind programme