Analgesic recommendations generally see a limited role, if any, for opioids in long-term pain. The FPM's Opioids Aware campaign was launched as prescribing data had shown a significant increase in their use for long-term pain. While there is very good evidence for opioids use in acute pain and end-of-life care, there is little evidence they are helpful for long-term pain, it says.18

A small proportion of people may obtain good pain relief with opioids long-term, €if the dose can be kept low and especially if their use is intermittent.€ However, the problem lies in identifying these people at the outset.

In addition, the risk of harm increases significantly above an oral morphine equivalent of 120mg per day, as there is no increase in benefit above this level. Indeed, opioids should be discontinued if the patient is still in pain and the opioids are not effective, even if no other treatment is available, says the FPM. It is important to consider emotional influences on pain and the patient's experience if pain symptoms are ongoing and causing disability.

The BMA's safer analgesic prescribing campaign additionally calls for doctors and patients to be supported around managing the use of opioids for pain, including support for stopping opioid treatment that is not working.17