Specific areas/situations where medication may need to be introduced or increased

If the presenting pain condition changes or symptoms worsen, undertake a further pain assessment, considering potential cause of flare-up and consider appropriate management (which may include rest, heat packs, pacing, use of short-term NSAID), dependent on the cause of the presenting pain.
Antidepressants:
- Before starting or continuing treatment with an antidepressant, ensure that all suitable management options, including non-pharmacological approaches and watchful waiting, have been discussed and offered. Explain and discuss the risk of dependence and the factors that may increase this risk.
- If treatment is reviewed and the individual has noticed an improvement in their quality of life, pain, sleep or psychological distress since the antidepressant was initiated, then a joint decision with the individual should be made whether continued treatment is needed. Always ensure ongoing review is in place to determine the benefits of continued prescribing.
Consider delaying prescribing if the person needs more time to think about their options or the prescriber needs to consult with other members of the healthcare team. If prescribing is delayed, ensure that a follow-up appointment and timeframe is agreed and arranged.