By Jake Francis
You may have noticed my recent pain series on Instagram (if not you can access the series here). I discussed what pain was and talked quite a lot about pain medication, what it is, how it works, etc. You may have got the impression that I am not a fan of pain medication. This is because I am not. However, it can be beneficial for the right person with the right condition.
Now, let's talk about what a GP can currently do with regards to pain. The NHS currently recommend you manage chronic pain through exercise, continue to work as much as possible, and see a physical therapist of some kind to help point you in the right direction where movement is concerned. So, in theory your GP should refer you to a therapist if you are complaining of chronic pain. However, the NHS also suggest that over-the-counter pain medication, like paracetamol or ibuprofen may be useful (up to 2 weeks, then go to see your GP). In my experience, clients with chronic pain have gone to see their GP and been given a prescription pain medication straight away, before coming to see me on there own volition. Currently, GPs can prescribe:
- Larger doses of paracetamol or ibuprofen
- Codeine (an opiate based drug)
- Amitriptyline (a drug usually prescribed for depression)
- Gabapentin (a drug usually prescribed for epilepsy)
- Morphine (the strongest and most addictive pain killer)
So, my question is, why are GPs allowed to prescribe all of these?
Pain is a complex physical and emotional response. It is affected by biopsychosocial factors (factors based on your own biology, mental wellbeing, and socioeconomic status). So when I am told by a client that in their first appointment with their GP, they were prescribed codeine or gabapentin or amitriptyline or a mixture of them, I have to wonder why. And let's be fair GPs are fantastic! They are general practitioners, they know a lot about a lot. However, they are not experts on any of it! If you are given the option and education to prescribe drugs for pain you would - they are doing their jobs, getting you out of pain. But, none of these work in the long run!
My opinion is, GPs should not be prescribing pain medication above the over-the-counter medication already available to everyone. They should be referring to a physical therapist of some kind, and if they still don't improve, then they should be referred to a pain specialist. Only a pain specialist should be allowed to prescribe pain medication for chronic pain.