Our Key Messages

Pain is a lived experience. The reality of living with pain is different for every individual.  

Pain medication is one piece of a pain management jigsaw, not the whole picture.  

Long-term, regular opioids are generally not recommended for chronic, non-cancer pain.  

Careful, collaborative, appropriate tapering of opioid medication saves lives.  

Faculty of Pain Medicine Statement

The Faculty of Pain Medicine is the professional body responsible for the training, assessment, practice and continuing professional development of specialist medical practitioners in the management of pain in the UK. Please see below their key messages around  Opioid Pain Management.

  1. Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long term pain.

  2. A small proportion of people may obtain good pain relief with opioids in the long-term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation).

  3. The risk of harm increases substantially at doses above an oral morphine equivalent of 120mg/day, but there is no increased benefit: tapering or stopping high dose opioids needs careful planning and collaboration.

  4. If a patient has pain that remains severe despite opioid treatment it means they are not working and should be stopped, even if no other treatment is available.

  5.  Chronic pain is very complex and if patients have refractory and disabling symptoms, particularly if they are on high opioid doses, a very detailed assessment of the many emotional influences on their pain experience is essential.

Taken from Opioids Aware | Faculty of Pain Management

Local Data

The Opioids in Non Cancer Pain Clinical Reference Group (CRG) are using local data on opioid prescribing to support its work. Data is provided to every GP practice in Lincolnshire bi-annually. 

If you work at a GP Practice within Lincolnshire and have not received this information, please contact the Medicines Optimisation team at licb.mo@nhs.net and we will be able to provide you with the latest information for your practice.

The chart below shows the total number of people in Lincolnshire prescribed opioids (as oral morphine equivalence). Lincolnshire are amongst the highest prescribers in the country.

Open prescribing opioids August 2.png

Taken from https://openprescribing.net/measure/opioidome/sicbl/71E/#opioidome
Last Updated August 2024

The Y-Axis is describing the "equivalent dose of oral morphine prescribed for every 1000 patients". As opioid medicines are all different strengths, this measure shows what the total would look like if each of those different medications were converted to their equivalent dose of oral morphine through an opioid conversion chart. This is described as below on the OpenPrescribing site:

"This measure describes the total Oral Morphine Equivalence (OME) in ALL opioid prescribing (excluding prescribing for addiction) including low-dose opioids in drugs such as co-codamol and co-dydramol. This measure is experimental and should be used with caution, as OME conversions vary in different reference sources. We have amended the measure to take into account changes in equivalency in the BNF."

Below is another chart showing "High Dose Opioids" for Lincolnshire. The chart shows that Lincolnshire are again amongst the highest prescribers of high dose opioid medications for the whole country and well above the national average, though there has been a slow reduction over the last four years.

Open prescribing opioids August.png

Taken from https://openprescribing.net/measure/opioidper1000/sicbl/71E/#opioidper1000
Last Updated August 2024

High dose opioids, as mentioned in the title of the chart, are considered to be a prescription equivalent to above 120mg of Morphine. The measure on the Y-Axis is showing an average of how many patients out of 1000 are prescribed a dose of opioids that meet this criteria.

While a measure of 1 or 2 may not seem like a lot, there are over 820,000 people in Lincolnshire, which means that roughly 14,000 people are on what would be considered a high dose opioid prescription. If Lincolnshire were closer to the national average this number would be closer to 8,000, which is a difference of 6,000 people. 

Prescriber Charter

The CRG along with local collaborators and the ICB (Integrated Care Board), has developed our Prescriber Charter, to support and advise prescribers across Lincolnshire.  

Download the Prescriber Charter here.

Patient Reference Group  

The CRG has established a Patient Reference Group, to support and guide our local projects.  

Our Patient Reference Group are a small group of volunteers that meet with us every few months, they all live in Lincolnshire and have experience living with pain. We seek their advice and guidance on various topics, such as our online content and where our focus is needed within the wider healthcare system.

If you live in Lincolnshire, have experience with pain and are interested in joining our Patient Reference Group, please get in touch with us at licb.patientmo@nhs.net.

Postoperative Patients  

The CRG supports the Centre for Postoperative Care position statement on Modified Release Opioids.  

There is evidence that the use of modified release opioids after surgery can lead to harm for patients 1. Adverse effects such as opioid induced ventilatory impairment, constipation, delayed mobilisation and long-term opioid dependence can hamper recovery and rehabilitation efforts.

These harmful effects have gained worldwide recognition, leading to a number of organisations from the UK, America, Australia and New Zealand recommending the avoidance of modified release opioids in the perioperative period 2-4. Postoperative pain is acute and largely self-limiting, differing in nature to pre-existing arthritic pain. The use of controlled release opioids in this setting confers no benefit for patients but carries an increased risk compared with immediate release formulations.

The Centre for Perioperative Care (CPOC) recommends that opioid prescribers follow best practice guidance from the Faculty of Pain Medicine (FPM) 2:

  • Avoid modified release opioids. Use simple analgesics such as paracetamol or NSAIDs (unless contraindicated). Use immediate-release opiates if these are not effective enough. If modified release preparations (including transdermal) are used, due care should be exercised as they have been associated with harm.
  • Develop local protocols for discharge medication with pharmacy and primary care. Document dose, duration and de-escalation.
  • Advise patients about safe self-administration, weaning and disposal of opioids, along with risks of adverse effects such as respiratory depression and sedation.

CPOC are currently working with FPM on a guideline for perioperative management of pain which will further inform this statement.

1. Levy N, Mills P. Controlled-release opioids cause harm and should be avoided in management of postoperative pain in opioid naïve patients. British Journal of Anaesthesia. 2019 Jun 1;122(6):e86-90.
2. Wilkinson, P., Srivastava, D., Bastable, R., Carty, S., Harrop‑Griffiths, W., Hill, S., Levy, N. and Rockett, M., 2020. Surgery and opioids: best practice guidelines 2021. Available from https://fpm.ac.uk/media/2721
3. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR Recommendations and Reports. 2022 Nov 4;71(3):1-95.
4. Australia and New Zealand College of Anaesthesia. 2022. PS41(G) Position statement on acute pain management. Available from https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51fd57556b0ffa7/PS41-Guideline-on-acute-pain-management

Taken from https://cpoc.org.uk/sites/cpoc/files/documents/2023-05/CPOC%20MR%20Opioid%20statement.pdf