Pain options for primary care while awaiting orthopaedic surgery

We are all aware of the pressures on elective surgery due to the pandemic. With this (and other factors) we have seen a national spike in opioid use.

Patients with osteoarthritis awaiting surgery have what the recent NICE guidelines refer to as “secondary chronic pain” (i.e. a pain of 3 months or more with a known identifiable cause). This can be a really difficult time for patients especially as they may believe that surgery, and medication for pain in the meantime, is the only way to relieve their symptoms. However, this is not necessarily true. The long term use of medication for pain, even while awaiting surgery, is not recommended by NICE. We know that opioids beyond 12 weeks carry more risks than benefits and there is also little evidence to support the use of gabapentinoids. Long term opioid use in advance of surgery is linked to a higher risk of long term opioid use following surgery. So it’s best not to add these medications to repeat and to always consider providing the MHRA leaflet on opioids , if prescribing at all.

Some available options for you to provide to patients to who are struggling with chronic joint pain and may or may not be on a list waiting for joint surgery could include: