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Capturing the perspectives on treatment of chronic non-cancer pain using non-pharmacological approaches

02 September 2023
Clinical Focus
02 September 2023
Volume 34 · Issue 9

Abstract

Opioid therapy was standard treatment for all types of pain, until the opioid epidemic in the US. Research has since uncovered a lack of efficacy for treating chronic non-cancer pain with opioids and the detrimental effects they may cause. By Sarah Westrap

Background

Opioid therapy was the mainstay of treatment for all types of pain, until the opioid epidemic of the 1980's – 2000's. Research has since uncovered a lack of efficacy for treating chronic non-cancer pain with opioids and the detrimental effects they may cause.

Aim

To uncover a range of perspectives which encompass the complexities of care of the patient with CNCP.

Methods

A critical review of the literature using qualitative study designs. Databases searched include Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index (BNI), Pubmed, Embase and PsychINFO. PICO search terms were used, and Boolean operators were applied. Research studies selected for inclusion were put through McMaster critical review forms and findings placed in a theme matrix.

Findings

There were 3 main themes that were drawn out from the research papers critiqued. These relate firstly to the patients perspective of living with chronic pain non-cancer pain. Patients seek adequate pain relief but have misgivings around the adverse effects of opioids, welcoming non-pharmacological approaches such as acupuncture and chiropractic treatment but patients view may be sceptic. Secondly the relationship between the patients and healthcare professional (HCP) can include clues during communication which may led to change in treatment. Lastly the views of HCP's who often cite lack of training in managing patients with chronic non-cancer pain and fear of difficult interactions regarding opioid use.

Conclusion

Individuals have unique characteristics; treatment models can be applied such as an integrated medical group visit (IMGV) or Horne model to connect HCP and patient, offering solutions in reducing or stopping opioid therapy.

Chronic non-cancer pain (CNCP) has been defined by the 2019 International Classification of Diseases version 11 (ICD-11) by differentiating between chronic primary pain and chronic secondary pain (Treede et al 2019). Chronic secondary pain is attributed to an underlying condition such as cancer (National Institute of Health and Clinical Excellence, NICE 2021a) whereas chronic primary pain has the pain condition predominating such as in fibromyalgia or low back pain (Treede et al 2019). Chronic primary pain is pain which has been present for greater than 3 months and is often out of proportion to expected healing times (NICE 2021a). The experience of chronic pain follows a biopsychosocial model of disease understanding from the work of Engel (1977) due to its close links to mental health. Social components include isolation, and deprivation, as well as the emotional aspects of stress and anxiety (NICE 2021a). CNCP is thought to affect between 35-51% of the United Kingdom (UK) adult population (Fayaz et al 2016).

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Chronic non-cancer pain
opioid therapy
non-pharmacological
pain management