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Medication review and optimisation

A medication review examines what you are currently taking for pain, what each medication is actually achieving, and what it is costing you in side effects. The aim is a regimen that gives the most benefit for the least harm, which often means fewer medications rather than more.

People with persistent pain often accumulate medications over years. Each was started for a reason, but the reasons are rarely revisited, and it is common to be taking several that are no longer doing much while carrying all of their side effects.

What the review does. For each medication: is it helping, and how would you know? Does its mechanism match the type of pain you have — because medications effective for nerve pain differ from those effective for inflammatory or mechanical pain, and mismatches are common. What is it costing you in sedation, cognitive fog, constipation, weight change, mood or sleep? Are any interacting with each other?

On opioids. Dr Martin does not generally support long-term opioid treatment for persistent non-cancer pain. This position reflects the evidence: benefit for most persistent non-cancer pain conditions is modest and tends to diminish over time, while risks — tolerance, dependence, hormonal and immune effects, increased pain sensitivity, and overdose — accumulate.

This is a position about the medication, not about you. People on long-term opioids were prescribed them in good faith, usually by doctors following the standards of the time, and did nothing wrong. Nobody will be lectured, and nobody will be dismissed from care for being on them.

Where reduction is appropriate, it is done slowly, on a plan agreed with you, with alternatives in place first and support throughout. Abrupt cessation is harmful and is not what happens here. Some people find that pain does not worsen with reduction and that clarity, energy and mood improve; that is a common outcome but not a guaranteed one, and the pace is set to what you can manage.

Cancer pain is different. The considerations above apply to persistent non-cancer pain. Pain related to cancer is managed on different principles.

What often replaces medication. Depending on your assessment: a targeted procedure addressing a specific pain generator, a medication better matched to your pain mechanism, structured exercise and pacing, sleep intervention, or psychological approaches for pain. Usually a combination.

Your GP stays central. Prescribing continues with your GP in the great majority of cases. Dr Martin's role is assessment, a clear written plan, and support in carrying it out.