Opioids have long played a role in the management of chronic pain — but as the evidence base has evolved, so too has our understanding of their limitations, risks, and role in long-term care.
For Australian GPs, navigating opioid prescribing has become increasingly complex, with growing regulatory scrutiny, PBS restrictions, and clinical uncertainty. Many GPs feel caught between the expectations of patients in pain, and a duty to practice safe, evidence-informed medicine.
At Axxon Pain Medicine, we work alongside GPs to provide non-surgical, interventional alternatives, while offering specialist support in rationalising or reducing opioid use. The aim is not to eliminate opioids from practice altogether — but to ensure they’re used thoughtfully, selectively, and as part of a broader strategy that prioritises function and quality of life.
The Changing Role of Opioids in Chronic Pain
While opioids remain effective for acute pain and cancer-related pain, their use in non-cancer chronic pain (CNCP) is increasingly discouraged due to:
Limited long-term efficacy: Tolerance often develops within weeks, with diminishing returns.
Risk of dependence and misuse: Even in compliant patients, dependency can arise insidiously.
Adverse effects: Cognitive slowing, constipation, hormonal disruption, falls, and sedation.
Dose escalation: Increasing doses rarely improve outcomes and compound the risk profile.
Despite this, many patients continue long-term opioids simply because there are few perceived alternatives, or because withdrawal feels unmanageable.
What GPs Are Telling Us
Common concerns we hear from GPs include:
“The patient insists opioids are the only thing that helps.”
“I inherited them on high-dose oxycodone and I’m not sure how to safely taper.”
“If I reduce the dose, I’m worried they’ll go to another clinic or deteriorate mentally.”
“I want to do the right thing, but I don’t have access to support or specialists.”
These are valid concerns. And they reflect a system where GPs are often expected to manage complex biopsychosocial pain syndromes in 15-minute consults — without access to specialist input.
How Pain Specialists Can Help
At Axxon Pain Medicine, our goal is to support GPs by offering:
1. Clinical Reassessment
We re-evaluate the pain condition itself. Is it neuropathic, mechanical, inflammatory, or centrally sensitised? Many long-term opioid users have never had a comprehensive pain diagnosis — which is critical before considering a wean.
2. Targeted Interventional Options
We use procedures such as:
– Nerve blocks
– Radiofrequency denervation
– Spinal cord stimulation
– Image-guided joint or epidural injections
These interventions can offer effective, localised relief — reducing or eliminating the need for systemic opioids.
3. Opioid Weaning Pathways
For suitable patients, we collaborate on structured tapering plans, with input from pain psychologists and GPs. This may include:
– Gradual dose reduction
– Substitution with non-opioid analgesics
– Adjunctive procedures to assist with pain control
– Patient education on pain neurobiology and functional goals
4. Psychosocial Support
Some patients experience grief, anxiety or identity loss when opioids are reduced. We coordinate care with pain psychologists and allied health professionals to ensure holistic support, not just dose reduction.
A Balanced Message for Patients
We’re mindful that many patients feel stigmatised when the conversation around opioids begins. That’s why we focus on language that:
– Validates their experience of pain
– Emphasises that there are other tools available
– Reframes success as improved function, not just lower pain scores
– Supports autonomy and shared decision-making
For example, instead of saying, “We need to get you off opioids,” we might say,
“Let’s explore some newer options that may help your pain with fewer side effects, so we can gradually reduce your reliance on daily medications.”
When to Refer
Consider referring to a pain specialist when:
– The patient is on opioids long-term (>3 months) without sustained benefit
– There is concern about opioid dependency, escalation or side effects
– The pain condition hasn’t been formally reassessed
– Conservative management has plateaued
– You are planning a weaning pathway and want allied support
Axxon’s Commitment to GP Collaboration
We know GPs are at the coalface of chronic pain. Our team at Axxon is committed to:
– Timely, collaborative communication
– Transparent, evidence-based treatment plans
– Minimising patient risk while preserving compassionate care
– Educating patients and GPs on the full suite of available options
Key Takeaways
– Opioids still have a place — but only as part of a broader, individualised pain strategy.
– Early referral can prevent dose escalation and reduce long-term harm.
– Interventional pain medicine offers real, evidence-based alternatives for many patients who are “stuck” on opioids.
– GPs don’t have to manage complex weans alone — specialist support is available.
For referrals or clinical advice, contact our team at Axxon Pain Medicine. We’re here to support you and your patients with expert, non-surgical pain solutions.
