.

3 Treatment for Chronic Non Cancer Pain

Chronic pain is a pain that persist for
more than 4
weeks
chronic
pain can arise from:

Tissue damage (nocice
ptive pain), e.g. arthritis,
fibromyalgia’s
, lower back
p
ain,
pleurisy, cancer pain etc
3
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
Injury to nerves (n
europathic pain) e.g. post herpetic neuralgia (pain following
shingles), trigeminal neuralgia, diabetic neuropathy, HIV related peripheral neuropathy,
drug induced peripheral neuropathy or phantom lim
b

Abnormal nerve activity following disease
Psychologica
l evaluation and behaviorally based treatment paradigms are frequently helpful,
particularly in the setting of a multidisciplinary pain
-
management center.
Drug Treatment
Mild Pain
Adult:
A:
Paracetamol 1
000 mg (O) 6 hourly
until pain subsides
Pain Assoc
iated with Trauma or Inflammation
See under Trauma and Injuries section
Moderate pain (Including neuropathy)
Adults:
If still no relief to simple analgesics as above,
add
C:
Tramadol 50 mg (O
)4
–
6 hourly as a starting dose
May be increased to a maximum of
400 mg daily
Adjuvant therapy
Adults: In addition to analgesia as above
add
antidepressants;
C:
Amitriptyline 25 mg (O)
at night; Maximum dose: 75mg.
Anticonvulsants and Antiarrhythmics
may also be helpful in neuropathic pain. Give
Phenytoin or carbamaz
epine.
Referral

Pain requiring strong opioids

Pain requiring defi
nitive treatment for the underlying disease

All children
1.4 Chronic Cancer Pain
The long
-
term use of opioids is accepted for patients with pain due to malignant disease.
S
ome
degree of tole
rance and physical dependence are likely with long
-
term use. Therefore, before
embarking on opioid therapy, other options should be explored, and the limitations and
risks of
opioids should be explained to the patient (
For detailed information, refer to Ma
lignant Disease
chapter
).