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Chronic Pain   Part 2    

Posted by Eamonn Brady on

Last week I discussed types, causes and diagnosis of chronic pain. This week and next week I discuss treatment




There is substantial evidence based on WHO figures that chronic pain is massively undertreated across the globe. Individuals with chronic pain often do not seek help with pain This occurs for a variety of reasons including religion, fear, finance, culture and a feeling that health care professionals may feel the individual’s pain is ‘imaginary’. Indeed, the fear of stigma and disbelief, especially with females is the most common reason in Ireland for not seeking help with chronic pain.



The effectiveness of medication depends on the nature and severity of the pain. Types of medications, their benefits and potential side effects described below. Most medicines described in this article by me are only available on prescription from your GP; speak to your GP or pharmacist for more details.



Can be used to treat pain anywhere in the body. Is considered generally safe without many side effects when used within recommended dose. Paracetamol does not have anti-inflammatory effects so may be less effective than NSAIDs for pain where inflammation occurs (eg) sprains and strains, arthritis. Rare side effects can include skin rash and kidney and liver problems especially if higher than the recommended dose is taken. Paracetamol can be used alone or with other drugs such as NSAIDs or a codeine-like opioid, such as co-codamol. Long term use of paracetamol and codeine combinations are not recommended (eg. Solpadeine®) as they can cause rebound headaches and addiction within as little as three days.

Non-steroid anti-inflammatories (NSAID’s)

Generally used for more severe pain, evidence shows Ibuprofen to be highly effective. Oral forms include ibuprofen, diclofenac, etoricoxib, ketorolac, naproxen and celecoxib. Uses include lower back pain; hip or knee pain; osteoarthritis pain (pain that affects joints) and musculoskeletal pain (pain that affects muscles, ligaments and tendons and joints).

Side effects can include stomach pain; diarrhoea; heartburn; high blood pressure; rash and headaches and dizziness. In a small number of people, NSAIDs can cause heart problems. Over-use can be associated with serious bleeding. For this reason, do not use NSAIDs with aspirin. If you have asthma, there is a risk of it becoming worse when taking NSAIDs.

Topical non-steroid anti-inflammatory drugs (NSAIDs)

Topical non-steroid anti-inflammatory drugs (NSAIDs) can be in the form of a gel, cream or patches for example ibuprofen (Ibugel® Gel), diclofenac (Diclac® Gel) and etofenamate (Etoflam® Gel). They can be considered when treating localised musculoskeletal pain, particularly if unable take NSAID tablets. Should be used for a short time. They work directly on the affected area of the body. There is less risk of side effects as the medication does not go through the whole body but are less effective generally than oral versions. Side effects are rare but some people can get mild skin reactions, for example a rash.

Other topical medicines

Other topical medicines (medication applied to the skin in the form of creams, gels or patches), for example: capsaicin; lidocaine patch and rubefacients (substance that produces redness of the skin). They can be considered for nerve pain or musculoskeletal pain which hasn’t improved with other medication, or if unable to t take other medication. They work directly on the affected area of the body. There is less risk of side effects as medication does not go through your whole body. Sometimes topical painkillers can cause redness, itching, stinging, burning or other skin reactions.


Opioids examples include codeine, dihydrocodeine, tramadol, oxycodone, hydrocodone, tapentadol, morphine, transdermal fentanyl, buprenorphine and methadone Opioids are generally reserved for more severe pain. Uses include chronic low back pain or osteoarthritis. They should only be continued if there is ongoing pain relief. Some opioids are weak (for example codeine) and some are strong (for example morphine). Because opioids can have serious side effects their long-term use should only be considered after a detailed discussion with GP. Common side effects include feeling sick; being sick; feeling dizzy; constipation; feeling sleepy; feeling confused; and breathing problems. Side effects associated with longer-term use of opioids include feeling lethargic; headaches; stomach problems (including constipation); urinary problems; reduced immunity to infections; hormone problems; dry mouth; over-sensitivity to pain or pain getting worse; addiction; mood changes; and sleep disturbances. Many come in patch form which may have less side effects than oral forms (eg) buprenorphine (Bu-trans®) patch.

To be continued…next week I discuss more treatment options

Disclaimer: Information given is general; Please ensure you consult with your healthcare professional before making any changes recommended

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