TREATMENTS
Many people living with chronic pain take medication every day, often for many years. Some find it life-changing. Others feel that their medicines no longer work, cause troublesome side effects, or have gradually increased without providing meaningful benefit. At Wye Sanctuary, we believe that medication should support your quality of life—not limit it. Medication optimisation is about ensuring that every medicine you take has a clear purpose, provides more benefit than harm, and forms part of a wider, personalised approach to pain management.
Medication optimisation is the careful review of all your pain medication. We ask whether each medicine is helping, whether the benefits are greater than the side effects, whether there is a safer or more effective alternative, and whether anything is missing from your treatment plan. Sometimes the answer is to continue, adjust the dose, change medication, or gradually stop something that is no longer helping.
One of the biggest misconceptions about chronic pain is that there must be a medication that can take the pain away completely. Unfortunately, this is rarely the case. Most medicines provide partial relief rather than eliminating pain altogether. Our aim is to find the smallest amount of medication that provides meaningful improvement while minimising unwanted side effects.
MEDICATION OPTIMISATION
Choosing the right medication for the right person at the right time.
Type of pain
Nociceptive, neuropathic or chronic primary pain
Benefits vs side effects
Is it improving your life?
Your health
Age, other conditions and other medicines
Regular review
Does it still have a clear purpose?
Shared decision-making
Choosing together
Part of a wider plan
Lifestyle, rehabilitation, procedures and education
PERSONALISED MEDICATION PLAN
The right medicine • The right dose • The right review
Rather than reviewing one prescription at a time, we look at your overall treatment. We consider your diagnosis, the type of pain you have, your age and general health, other medical conditions, sleep, mood, previous treatments, other medications and your personal goals. This allows us to tailor treatment to you rather than simply following a standard prescribing pathway.
Nociceptive pain
Pain arising from joints, muscles, ligaments or inflammation may respond to paracetamol, anti-inflammatory medication, or occasionally opioid medication for short periods.
Neuropathic pain
Pain caused by irritation or damage to nerves often responds better to medicines such as amitriptyline, nortriptyline, duloxetine, gabapentin or pregabalin. These work differently from ordinary painkillers and are often used in lower doses than when treating other conditions.
Chronic primary pain
Conditions such as fibromyalgia or chronic widespread pain rarely respond well to strong painkillers alone. Treatment is usually most effective when medication is combined with lifestyle approaches, pain education, physiotherapy, psychological therapies, Pain Reprocessing Therapy where appropriate, or medical cannabis for selected patients.
Medicines such as morphine, oxycodone, fentanyl and buprenorphine can play an important role in some situations. However, they are usually less effective for long-term chronic pain than many people expect. Over time, some people experience reduced effectiveness, increasing doses, drowsiness, constipation, hormonal changes, reduced concentration or increased sensitivity to pain. This does not mean opioids are bad. It means they should be reviewed regularly to ensure they remain helpful.
Some people actually feel better after reducing medication because side effects improve, concentration returns, energy levels increase or sleep improves. Any reduction should always be gradual and carefully supervised. We never recommend stopping long-term medication suddenly.
Pain medication can affect many aspects of daily life. Common side effects include drowsiness, dizziness, constipation, dry mouth, weight gain, poor concentration, reduced libido and nausea. Where possible, we aim to minimise these while maintaining symptom control.
For carefully selected patients whose chronic pain has not responded to conventional treatments, medical cannabis may be considered. It is not suitable for everyone and is never recommended as a first-line treatment. When prescribed appropriately, it forms part of a wider management plan rather than replacing other approaches.
Every decision about medication should be made together. You should understand why a medicine is being recommended, what benefits you might realistically expect, possible side effects, alternative options and when it should be reviewed. Good prescribing is about partnership rather than simply writing prescriptions.
Medication reviews are a core part of our approach to chronic pain management. During your consultation, we take time to understand what you are taking, how well it is working and whether it continues to support your quality of life. Sometimes the best decision is to continue your current treatment. Sometimes we may recommend adjusting doses, changing medication or gradually reducing medicines that are no longer providing benefit. Every recommendation is individual, evidence-based and made in partnership with you.
“Many people come to clinic hoping I’ll recommend a new medication. Sometimes I do, but often the most important conversation is about the medicines you’re already taking. Good pain management isn’t about collecting more prescriptions—it’s about making sure every medication has a clear purpose and genuinely improves your life. My aim is to help you find the simplest, safest and most effective treatment plan for your individual situation.”