Medicines optimization in acute and chronic pain


      Pain is a complex condition and warrants a multidisciplinary approach based on a bio-psycho-social model. Whilst often successful in acute pain, pharmacological treatment is rarely successful on its own in the management of chronic pain due to the high number of patients needed to treat to achieve a clinically meaningful improvement in function, quality of life and pain scores. There are also significant side effects in the short and long term. Recent re-analysis of clinic trial data focused on individual responder rates, showed that there is a cohort of patients who achieve 50% pain relief with subsequent improvement in physical function. To avoid intolerable side effects from medication used for chronic pain, titration needs to be slow and aimed towards the agreed risk–benefit between patients and treating physician with a clear plan for weaning and cessation if these goals are not achieved. Pain-orientated physiotherapy, either on its own or as part of a pain management programme, should be offered and medication reduced or weaned after restoration of function has been achieved.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Anaesthesia & Intensive Care Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. International Association for the Study of Pain. IASP Terminology. (accessed 20 Jan 2022).

        • Leeuw M.
        • Goossens E.J.B.
        • Linton S.
        • et al.
        The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.
        J Behav Med. 2007; 30: 77-94
        • Andrew R.
        • Derry S.
        • Taylor R.S.
        • et al.
        The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain.
        Pain Pract. 2014; 14: 79-94
        • Moore R.A.
        • Cai N.
        • Skljarevski V.
        • et al.
        Duloxetine use in chronic painful conditions--individual patient data responder analysis.
        Eur J Pain. 2014; 18: 67-75
      2. National Institute for Health and Care Excellence (NICE). Medicines optimisation in chronic pain. (accessed 20 Jan 2022).

        • West S.J.
        • Bannister K.
        • Dickenson A.H.
        Circuitry and plasticity of the dorsal horn - toward a better understanding of neuropathic pain.
        Neuroscience. 2015; 300 (6): 254-275
        • Üçeyler N.
        • Sommer C.
        High-dose capsaicin for the treatment of neuropathic pain: what we know and what we need to know.
        Pain Ther. 2014; 3: 73-84
        • Wiffen P.J.
        • Derry S.
        • Bell R.F.
        • et al.
        Gabapentin for chronic neuropathic pain in adults.
        Cochrane Database Syst Rev. 2017; 6: CD007938
        • Stannard C.
        Where now for opioids in chronic pain?.
        Drug Ther Bull. 2018; 56: 118-122
      3. Faculty of Pain Medicine. Opioids-Aware. (accessed 25 Jan 2022).

        • Smith D.M.
        • Weitzel K.W.
        • Cavallari L.H.
        • et al.
        Clinical application of pharmacogenetics in pain management.
        J Pers Med. 2018; 15: 117-126
        • Labau J.I.R.
        • Estacion M.
        • Tanaka B.S.
        • et al.
        Differential effect of lacosamide on Nav1.7 variants from responsive and non-responsive patients with small fibre neuropathy.
        Brain. 2020; 143: 771-782
        • Gallagher P.
        • Ryan C.
        • Byrne S.
        • et al.
        STOPP (screening Tool of older persons' prescriptions) and START (screening Tool to alert doctors to right treatment): consensus validation.
        Int J Clin Pharmacol Ther. 2008; 46: 72-83