Introduction
Jennifer’s account of living with and managing chronic pain
“I have been suffering from chronic pain since 2014. I had an operation on my back about ten years ago, as I had benign tumours on my hips and neck. Five years ago, I had a spinal leakage, and then had sepsis and meningitis and was in and out of hospital many times. I was in chronic pain all throughout my illness, which includes fibromyalgia, and was on constant painkillers. For almost three years I was taking high dose opioids.
It feels like I actually lost three years of my life as I was spending up to 19 hours a day in bed. I lost interest in everything and just couldn’t do anything. I was in constant pain, even with the pain medicines, and I wasn’t able to go out.
I was referred to the Pain Team and they greatly helped me to manage and reduce my medication. I feel now that I am getting part of my life back. I am still in pain, but I was also in pain when I was on the high doses of opioids. If I have a bad day now, I will rest but when I feel a bit better, I try to get dressed and go out.
I take pride in my appearance again. I now feel better in myself as I was very low in spirit, when I was very ill and on the maximum pain medicines. I feel as though I am part of my old self again and look forward to making things better.
I am still not free from chronic pain, but I feel very grateful for the help of the doctor and Pain Team to help me feel as well as I can possibly be. It took a lot of determination to reach this point, but I feel a lot better now that I have reduced my medication. I am less tired and have more energy. I feel like a new person now.”
How our understanding of medicine use in chronic pain is changing
The use of analgesics in chronic pain is changing, as more evidence is available:
- about longer term risks and harms
- what groups of medicines can be used for different indications/conditions
- the benefits of non-pharmacological treatments
A summary of treatment options and indications is included alongside this guide as a supporting document (based on that of NHS Fife).
Numbers Needed to Treat (NNT)
This guide intends to be a practical tool to help prescribers decide when it is appropriate to initiate and continue medicines for people with chronic pain. In some circumstances it may be appropriate to discontinue treatments. Presentation of the number needed to treat (NNT) for a range of medicines is a tool that prescribers may use to aid discussions with individuals
The NNT is defined as the expected number of people who need to receive the intervention (be it a medicine, treatment, change) rather than the comparator intervention for one person to either incur or avoid an event in each time frame. An NNT of 10 can be interpreted that one additional (or less) person will incur an event for every 10 participants receiving the experimental intervention rather than control over a given time frame. This is referred to as the NNT to benefit.
For more information on NNTs please see Numbers Needed to Treat (NNT).