Managing Chronic Pain with Medication – A UK Perspective

Isabel D White

When the ache lingers beyond a few weeks, it is no longer just discomfort; it becomes a companion that shapes daily life. In the United Kingdom, chronic pain affects one in ten adults, and medication remains a cornerstone of treatment even as non‑pharmacological options grow.

The Landscape of Chronic Pain Treatment in England

Unlike acute pain, which is often brief and well‑targeted, chronic pain is an evolving story. It may stem from osteoarthritis, neuropathy, fibromyalgia or a lingering injury. Because the body’s response changes over time, clinicians must continually reassess both diagnosis and therapeutic approach.

In 2025 the National Institute for Health and Care Excellence (NICE) published guidance on pharmacological management of chronic pain, underscoring that opioids should be reserved for short‑term use or end‑of‑life care. The guidance emphasises a stepped‑care model: start with non‑opioid analgesics, then add anticonvulsants or antidepressants before considering opioids.

Primary care practices across the UK now have access to the NHS Chronic Pain Toolkit, which provides evidence‑based pathways and patient education materials. This toolkit helps GPs balance efficacy, safety and cost while respecting individual preferences.

Key Pharmacological Options

• Paracetamol (acetaminophen) – first line for mild to moderate pain; safe at doses up to 4 g/day.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs) – effective for osteoarthritis and musculoskeletal pain but carry gastrointestinal, renal and cardiovascular risks.
• Adjuvant analgesics – such as duloxetine or pregabalin, useful in neuropathic pain and fibromyalgia.
• Opioids – reserved for cases where other medications fail; strict monitoring required due to dependence and overdose potential.

Choosing the Right First‑Line Medication

The choice of initial therapy hinges on pain type, comorbidities and patient history. For osteoarthritis, NSAIDs or paracetamol are common starting points. If a patient has depression or chronic anxiety, an antidepressant like duloxetine may double as mood stabiliser and analgesic.

Consider the following decision tree when evaluating a new chronic pain case:

The Role of Opioids in the UK: A Cautious Approach

Opioid prescribing has become a contentious topic. The NHS Opioids Guidance highlights that only 1–3 % of patients with chronic pain benefit from long‑term opioid therapy, and the benefit is often modest.

When opioids are deemed necessary, clinicians follow strict protocols:

• Start low, go slow: begin with a minimal effective dose and titrate slowly, monitoring for side effects.
• Regular review: reassess every three months to evaluate efficacy and dependence risk.
• Multidisciplinary support: involve pharmacists, physiotherapists and pain specialists in the care plan.

The risk of harm rises sharply at oral morphine equivalents (OME) above 120 mg/day. At this threshold, clinicians are advised to consider tapering or cessation unless exceptional circumstances apply.

Opioid Tapering: A Stepwise Plan

1. Assessment: gauge pain intensity, functional status and psychological wellbeing.
2. Patient‑centred discussion: explain the taper schedule and address fears about withdrawal.
3. Gradual dose reduction: reduce by 10–20 % every two to four weeks, adjusting based on tolerance.
4. Supportive measures: use non‑opioid analgesics, cognitive behavioural therapy and physical activity to manage withdrawal symptoms.
5. Monitoring: record pain scores, mood changes and any adverse events in the patient’s electronic health record.

Integrating Non‑Pharmacological Therapies

A holistic strategy often yields better outcomes than medication alone. The UK’s National Health Service promotes a multimodal approach:

• Physical therapy: tailored exercise programmes improve joint mobility and muscle strength.
• Cognitive behavioural therapy (CBT): helps patients reframe pain perceptions and develop coping strategies.
• Mind‑body practices: yoga, tai chi and mindfulness meditation have shown modest benefits in reducing pain severity.
• Acupuncture: evidence suggests it can provide short‑term relief for back pain and osteoarthritis.

When combined with pharmacological treatment, these interventions reduce the need for higher opioid doses and mitigate side effects. Patients who actively engage in self‑management often report improved quality of life.

Case Study: Mrs. A., 58 Years Old – Osteoarthritis and Chronic Pain

Mrs. A presented with knee osteoarthritis, reporting a pain score of 7/10 on the Numeric Rating Scale (NRS). Her GPs started her on ibuprofen 400 mg three times daily, monitoring for gastrointestinal upset. After six weeks, pain reduced to 4/10, but she reported fatigue and mild dizziness.

Her GP then added a low‑dose duloxetine (30 mg nightly) to address potential neuropathic components. Within four weeks, her NRS dropped to 2/10, and she regained confidence in walking without assistance. The case illustrates how combining NSAIDs with an adjuvant can obviate the need for opioids.

Monitoring Safety: Adverse Effects and Drug Interactions

Medication safety is paramount, especially when polypharmacy is common among older adults. A systematic review published in 2025 identified that up to 30 % of chronic pain patients on multiple drugs experience at least one adverse event.

Clinical pharmacists routinely review medication lists for drug‑drug interactions, especially in patients receiving opioid therapy. Electronic prescribing systems now flag high‑risk combinations automatically.

When to Escalate Care

• If pain remains >5/10 despite a full course of non‑opioid and adjuvant therapies.
• If functional impairment escalates, affecting work or social activities.
• When psychological distress—depression, anxiety or insomnia—interferes with pain management.

In such scenarios, referral to a specialist pain clinic is recommended. These clinics employ multidisciplinary teams and advanced diagnostics, including imaging and nerve blocks, to tailor treatment plans.

The Impact of Policy and Reimbursement on Medication Choices

Prescription cost containment measures influence prescribing patterns across the UK. The NHS uses the Drug Tariff to set standard costs for medicines, ensuring equitable access while encouraging cost‑effective choices.

• Paracetamol 500 mg tablets: £0.05 per dose under the drug tariff.
• Ibuprofen 400 mg tablets: £0.10 per dose.
• Duloxetine 30 mg capsules: £1.20 per dose, with a maximum of 90 days’ supply for chronic pain.
• Opioid prescriptions are capped at 28 days in primary care unless specialist approval is obtained.

The NHS also promotes the use of generic formulations where available, which reduces out‑of‑pocket costs for patients and frees resources for other services.

Funding Initiatives: The Chronic Pain Initiative

The Department of Health’s 2025 Chronic Pain Initiative allocates £15 million to fund community‑based programmes that combine medication management with physical therapy and psychological support. Early data from pilot sites show a 25 % reduction in opioid prescriptions after two years of integrated care.

Future Directions: Precision Medicine and Digital Health

Genetic profiling may soon inform analgesic selection, identifying patients likely to respond to specific drugs while minimizing adverse events. For example, CYP2D6 polymorphisms affect morphine metabolism, suggesting alternative opioids for poor metabolisers.

Digital platforms such as the NHS App allow patients to log pain scores, medication adherence and side effects in real time. These data feed into machine‑learning algorithms that predict flare‑ups and recommend preemptive dose adjustments, potentially reducing emergency department visits.

Wearable Sensors: A New Frontier

Devices that track gait speed, muscle activity and heart rate variability provide objective measures of pain impact. In a 2025 pilot study across three UK hospitals, patients wearing sensors reported earlier detection of pain spikes, allowing clinicians to intervene before the pain escalated.

Practical Take‑aways for Patients

• Always read medication leaflets and ask your pharmacist about side effects.
• Keep a pain diary: note triggers, relief measures and daily activity levels.
• Engage in at least 30 minutes of moderate exercise most days, unless contraindicated.
• Seek professional support if you feel your medication is not working or causing distress.