Patients worry that pain levels will worsen if morphine is taken away

Torbay Weekly

I have been a consultant at Torbay Hospital for 12 years and I specialise in pain medicine.

Recently NICE published new guidelines on the treatment of chronic primary pain, and this has caused a lot of concern for patients with pain.

The main reason for this is that the new guidelines say that doctors should not prescribe morphine-type medicines for pain, and patients who are on these medications worry that they will be stopped.

Similar guidelines also exist for the treatment of long-term back pain.

Patients worry that if their morphine is taken away that the pain levels will worsen.

In my experience - and this is backed up by a lot of research evidence - patients who have been taking morphine-type drugs daily for more than several months rarely get any pain relief from the drug.

This is because patients develop tolerance to the drug much in the same way that someone who drinks alcohol regularly will need to drink more to get the same effect.

If a drug is helping control pain, a stranger would not realise that the patient has moderate or severe pain.

Patients who still have moderate or severe pain despite taking pain killers are likely to have developed tolerance to them, and the best treatment is to slowly reduce the amount of pain killers used and then come off them for a period of time.

The vast majority of my patients who do this find that their pain does not worsen, they start to feel a lot better in themselves, become less anxious and have more energy.

Most of my patients do not want to go back onto morphine-type drugs because they find that they do not work when they try them again.

There are lots of other ways to control pain without needing to use painkillers.

ReConnect2Life is section of the Torbay Hospital website that covers this in detail -

If you think that your painkillers are not allowing you to live the life you want to live, please talk to your healthcare professional about this.

Please do not suddenly stop your pain killers, as this will make you feel very rough, and you can have a short-term flare in pain.

One of our former patients is Louise Trewern who came off her opioids a few years ago, and is now in charge of our volunteer group, and also undertakes work nationally on opioid withdrawal.

Louise said: "I had been taking opioids for many years to treat my pain from fibromyalgia and osteoarthritis, believing that my pain was so bad because those conditions were worsening.

"I went to my GP to request yet another increase in the dose and after telling me he could not increase it further, he referred me to the pain rehabilitation service at Torbay Hospital where I met a wonderful clinical nurse specialist (CNS) who told me that because my pain was so bad, that meant the opioids were not working!

"I had become oversensitive to everything and could not even tolerate the cat walking across my lap!

"My quality of life had deteriorated so much over the years I was taking opioids, unbeknown to me at that time, I was suffering from the symptoms of long-term use of opioids, not my worsening conditions.

"I eventually went into Newton Abbot Community Hospital under the care of Dr Gunatileke and Dr Burrows to come off my opioids. It was an uncomfortable week in hospital and took me a few months for my body to properly adjust but I can honestly say that I have never felt better!

"Yes, I still live with pain but it's nowhere near as bad as it was when I was on all the opioid medication. I self-manage my pain now by keeping as active as possible. My quality of life is so much better."