Polypharmacy in chronic pain
Chronic pain: Quality prescribing - A guide for improvement 2026-2029
Polypharmacy is common in those with chronic pain due to other co-morbidities. A person-centred approach should be considered, utilising the 7-Steps medication review process.
The 7-Steps medicine review process
A high-risk combination which increases the risk of sedation, falls and the potential for dependency is three or more of:
- opioid
- antidepressant
- gabapentinoid
- benzodiazepine/z-drug
- antipsychotic
Prescribers should consider the total benzodiazepine-type drug load prescribed per day. Benzodiazepines, z-drugs and gabapentinoids have similar adverse effects such as sedation and respiratory depression. Along with this, an individual’s comorbidities may make them more susceptible to medicine-related harms e.g. increased breathlessness, fatigue and respiratory depression, which can be potentially fatal.
Reduction should be gradual. Stopping any of these medicines abruptly can cause discontinuation/withdrawal symptoms, such as dizziness, drowsiness, insomnia, irritability, headache, nausea and vomiting.