Managing Chronic Pain Without Opioids: Safe Non-Opioid Options in Primary Care

• 10th June 2024
• Clinically reviewed by: Adeem Azhar, MPharm, IPres

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• What is chronic pain?
• Why opioids are not always the right long-term answer
• How to relieve pain without pills
• Non pharmacological treatment for pain
• Non pharmacological management of pain in primary care
• Non opioid pain medications
• Medication review and deprescribing
• Building a personalised pain management plan
• How we support chronic pain medicines optimisation

Managing Chronic Pain Without Opioids means using safer, structured approaches that reduce reliance on opioids where they are not suitable for long-term use. In primary care, this may include non-drug therapies, lifestyle support, non opioid pain medications, regular medication review and careful medicines optimisation.

Key takeaways

• Chronic pain should be assessed carefully because chronic primary pain and chronic secondary pain may need different approaches.
• Non opioid pain control can include physical activity, psychological support, self-management, non-drug therapies and appropriate medicines review.
• Clinical pharmacists can support safer opioid use, deprescribing and medicines optimisation where long-term pain medicines need review.

What is chronic pain?

Chronic pain is pain that lasts for more than 3 months. It can affect movement, sleep, mood, work, relationships and day-to-day quality of life.

In primary care, chronic pain is usually considered in two broad groups:

• Chronic primary pain: Pain with no clear underlying condition, or pain where the impact is out of proportion to visible injury or disease
• Chronic secondary pain: Pain linked to an underlying condition, such as osteoarthritis, inflammatory disease, nerve damage or another diagnosed health problem

This distinction matters because treatment should be based on the type of pain, the patient’s goals, their wider health needs and the risks linked to medicines.

Why opioids are not always the right long-term answer

Opioids can be appropriate in some situations, including acute pain, cancer pain, palliative care or end-of-life care. However, long-term opioid use for chronic non-cancer pain can create risks and may not provide sustained benefit for every patient.

Potential risks include:

• Tolerance, where higher doses may be needed for the same effect
• Dependence and withdrawal symptoms
• Constipation, drowsiness and falls risk
• Reduced alertness and driving safety concerns
• Interactions with other medicines
• Hormonal effects and other long-term side effects
• Worsening pain sensitivity in some patients

Patients should not stop opioids suddenly without clinical advice. If reduction is appropriate, it should be planned gradually with support, monitoring and clear communication.

How to relieve pain without pills

Many patients ask how to relieve pain without pills, especially if they are worried about long-term medicines or side effects. The safest answer depends on the cause of pain, but non-drug support can play an important role.

Options may include:

• Gentle physical activity built up gradually
• Physiotherapy or musculoskeletal support
• Pain management programmes
• CBT or acceptance and commitment therapy
• Pacing and activity planning
• Sleep routine support
• Stress management and relaxation techniques
• Weight management where relevant
• Social support and self-management education

The aim is not always to remove pain completely. For many patients, the goal is to reduce the impact of pain, improve daily function and support safer long-term management.

Non pharmacological treatment for pain

Non pharmacological treatment for pain means using approaches that do not rely on medicines. These options can be especially useful where pain is long term, complex or affected by sleep, mood, stress, movement and confidence.

Common options include:

• Physiotherapy to support movement, strength and function
• CBT to help manage pain-related distress and coping
• Acceptance and commitment therapy to support day-to-day living with pain
• Mindfulness or relaxation techniques where appropriate
• Supported exercise programmes
• Pain education and self-management support

These approaches should be matched to the patient’s pain type, preferences and access needs. They work best as part of a broader care plan rather than as isolated advice.

Non pharmacological management of pain in primary care

Non pharmacological management of pain is most effective when it is realistic and tailored. Patients with chronic pain may also be dealing with fatigue, low mood, poor sleep, reduced mobility or fear of making pain worse.

Primary care teams can support this by:

• Discussing what matters most to the patient
• Setting realistic goals around function and daily activity
• Encouraging gradual movement rather than sudden overactivity
• Supporting pacing to avoid boom-and-bust patterns
• Signposting to physiotherapy, MSK services or pain services where appropriate
• Reviewing mental health, sleep and social factors
• Agreeing follow-up rather than giving one-off advice

The focus should be practical support that fits the patient’s life, not generic lifestyle advice.

Need stronger medicines optimisation for patients with chronic pain?

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Non opioid pain medications

Non opioid pain medications may help some patients, but the right choice depends on the diagnosis, pain type, other conditions, existing medicines and treatment goals.

Options may include:

• Paracetamol or NSAIDs for some short-term or condition-specific pain where appropriate
• Topical NSAIDs for some localised musculoskeletal pain
• Antidepressants or anticonvulsants in selected neuropathic pain pathways
• Medicines used as part of specialist-led pain management
• Treatment of the underlying condition where pain is secondary to another illness

All medicines should be reviewed regularly. If a medicine is not improving pain, function or quality of life, or if it is causing side effects, it should be reassessed.

Medication review and deprescribing

Medication review is important for patients with chronic pain because medicines can be added over time without always being reviewed against current benefit and risk.

A structured review can assess:

• What medicines the patient is taking
• Whether each medicine is still needed
• Whether pain or function has improved
• Whether side effects are affecting quality of life
• Whether doses remain appropriate
• Whether there are interactions or duplication
• Whether deprescribing may be safer
• Whether specialist input is needed

Deprescribing should be handled carefully, especially where medicines may cause withdrawal symptoms. Patients need time, explanation and support.

Building a personalised pain management plan

A personalised plan helps patients and clinicians agree what support is realistic and what outcomes matter most.

A strong plan should include:

• The type of chronic pain being managed
• The patient’s priorities and goals
• Current medicines and previous treatments
• Physical and emotional impact of pain
• Non-drug support options
• Monitoring and follow-up arrangements
• Safety-netting and escalation routes
• Review of medicines, risks and side effects

For primary care teams, the plan should be documented clearly so GPs, pharmacists, pharmacy technicians, nurses and specialist services can work consistently.

Core Prescribing Solutions Insight: What we see in primary care

In primary care, chronic pain often becomes harder to manage when medicines are added over time without a clear review of benefit, risk and patient goals. A structured pharmacist-led review helps identify whether current treatment is still helping, whether side effects or dependence risks are present and whether a safer, more personalised plan is needed.

Expert comment from our CEO and qualified clinical pharmacist:

Managing chronic pain safely requires more than replacing one medicine with another. In primary care, the priority is to understand the type of pain, review whether current medicines are still helping and support patients with realistic, personalised plans. Pharmacist-led medication reviews can play an important role in safer opioid use, deprescribing and medicines optimisation.

Adeem Azhar, Co-Founder and CEO, MPharm, IPres, Core Prescribing Solutions

How we support chronic pain medicines optimisation

Chronic pain medicines need regular review, especially where opioids, polypharmacy or long-term prescribing risks are involved. Our clinical pharmacy team helps GP practices and PCNs assess whether current treatment is still safe, effective and aligned with the patient’s goals.

We can support with:

• Pharmacist-led medication reviews for patients using long-term pain medicines
• Opioid review and gradual deprescribing support where clinically appropriate
• Medicines optimisation for patients with chronic pain, polypharmacy or high-risk prescribing
• Pharmacy technician input for monitoring, recalls and follow-up workflows
• Clear escalation where pain management needs GP, specialist or face-to-face review

This supports safer prescribing and gives practices a more structured way to manage chronic pain medicines in primary care.

FAQs

Can chronic pain be managed without opioids?

Yes, some patients can manage chronic pain without opioids or with reduced opioid use, depending on their condition and clinical needs. Support may include physiotherapy, psychological therapies, self-management, non opioid pain medications, medication review and specialist input where needed.

What is non opioid pain control?

Non opioid pain control means managing pain without relying on opioid medicines. It may include non-drug therapies, physical activity, psychological support, topical treatments, selected non-opioid medicines and regular review of the patient’s care plan.

What are common opioid alternatives for chronic pain?

Opioid alternatives may include physiotherapy, CBT, pain management programmes, self-management support, topical treatments, selected non-opioid medicines and review of the underlying condition causing pain.

Should patients stop opioids if they have chronic pain?

Patients should not stop opioids suddenly without clinical advice. If opioids are no longer helping or are causing harm, a clinician may recommend a gradual reduction plan with appropriate monitoring and support.

How can clinical pharmacists support chronic pain management?

Clinical pharmacists can review pain medicines, assess benefit and risk, identify side effects or interactions, support safer opioid reduction where appropriate and help improve medicines optimisation across primary care.

Build a safer medicines strategy for chronic pain management

Core Prescribing Solutions can support GP practices and PCNs with Clinical Pharmacist-led medication reviews, medicines optimisation and deprescribing support within appropriate clinical scope. We can help identify medicine-related risks, review complex treatment regimens and strengthen monitoring and prescribing workflows for patients living with chronic pain.

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