How does pain medication work?

Chronic pain management is complex, and medication is often a part of this.

Let’s take a look at some commonly prescribed pain medications:

Benzodiazepines can provide a relaxing effect from chronic pain and related effects, like anxiety and insomnia. They can be helpful when used with other forms of therapy – but they can also be dangerous in high doses and when combined with alcohol and other drugs.³

There are three types of benzodiazepines: long, intermediate, and short-acting.

Common names for long acting benzodiazepines are diazepam (Valium®); intermediate acting benzodiazepines are nitrazepam (Alodorm®, Mogadon®); and short acting benzodiazepines are oxazepam (Serepax®), temazepam (Euhypnos®, Normison®) and alprazolam (Xanax®, Kalma®, Alprax®), among others.⁴

In 2020, benzodiazepines accounted for 36% of all unintentional drug-induced deaths in Australia; this was the second-most common drug group identified, behind opioids.⁵

The risk of developing a dependence increases the longer you are on the drug.

It generally shouldn’t be used for longer than two weeks.

However, benzodiazepines are one of the most commonly used medications in Australia with long term prescribing contributing to non-medical use and dependence.⁶

Opioids such as codeine, fentanyl, and oxycodone can be effective in the short-term but have been shown to lose effectiveness quickly.

They can also be dangerous in high doses and when combined with alcohol and other drugs.^3,7

Common types of opioid-based medications include codeine (Panadeine®, Panadeine Forte® and Nurofen Plus®), fentanyl, morphine, oxycodone (Endone® or OxyContin®), buprenorphine (Subutex® or Suboxone®), methadone and tramadol, among others.³

In 2020, pharmaceutical opioids accounted for 47.3% of unintentional drug-induced deaths in Australia involving opioids.⁵

Opioids often help many Australians experiencing strong and intense pain, for example after surgery or dental work.

However, Australians are increasingly using them for longer and experiencing negative side effects and harms, including dependence.⁸

According to the Therapeutic Goods Association (TGA), in 2020 only half (56%) of consumers using opioids felt they were using them safely, and around one-third (30%) felt they were dependent on their opioid medication.⁹

But simply stopping the use of opioids and benzodiazepines doesn’t fix the problem of chronic pain as you will still need support to address underlying health concerns.

It’s important that your withdrawal and tapering off process is supported by your GP and specialist support where needed.^10,11

In the 2022 Pain Australia survey on the impact of opioid reforms, 61% of people who had their medication stopped or reduced said they would like to be more involved in the decision regarding their medication.¹

If you’re concerned for your wellbeing, you can speak to another GP or doctor who will support you to slowly come off your prescription, safely. You can also ask your local pharmacist for advice. Do not stop taking medication without first talking to your GP.

My GP will no longer prescribe me my pain medication

Due to the lack of services and long wait times to see a pain specialist in Australia, medicines have often been the main treatment for people living with chronic pain.¹

But in an effort to reduce the harm, opioid reforms were introduced in June 2020 and guidelines for pain management shifted away from these prescriptions, towards alternative medicines and therapies.¹²

The Australian Government also has to approve doctors to prescribe drugs of dependence which include medications commonly used in chronic pain management.¹⁴

This has seen a decrease in prescribing patterns.

According to Pain Australia after the opioid reforms in June 2020, 37.7% of survey participants said their opioid medication had been reduced, and 18.5% had their medication ceased.¹

If you’re living with chronic pain, being cut off from your routine opioid or benzodiazepine prescription can make you feel lost, alone,
and unsupported.

But you’re not alone, this is an increasingly common experience, and help is available.

What can I do to self-manage my chronic pain?

If you have chronic pain, it’s important to learn how to manage it on a daily basis, with the support of loved ones and health professionals - and not only through medication.¹³

The following tips from Pain Australia can help you manage the physical, psychological and social factors that impact your pain.

• Daily stretching and walking. Start small and increase your activity slowly, you can ask a physiotherapist to help you out with an exercise program.
• Pacing activities. Be sure to plan daily rest and stretch breaks and keep physical activity at an even pace throughout the day.
• Relaxation techniques such as deep-breathing, yoga, and meditation.
• Mindfulness exercises can help you learn how to accept and explore your thoughts and feelings, including your pain.
• Desensitisation and distraction is about retraining your brain to respond differently to pain. Distraction can help you focus on something you enjoy, such as listening to music, rather than focussing on your pain.
• Cognitive Behavioural Therapy (CBT) is a common psychological therapy to help people explore their thoughts, feelings, and behaviours associated with pain. Your GP can help you find a psychologist to help you with this.
• Sleep - ongoing restful sleep can help you manage the symptoms of pain.
• Diet and exercise - low impact exercises and a diet that works well for the needs of your body can support you in managing your pain.
• Support groups - chronic pain can be an isolating experience and finding a community of people who are familiar with your experience can be helpful.^2,13

If you want to find out more about chronic and persistent pain, check out some of these resources:

National Pain Services Directory

Pain Australia - Factsheets

Pain Australia – Getting the right care

Pain Australia – Care in community

Chronic Pain Australia

vAustralian Pain Management Association

Getting support:

Speak to a Peer Guide on the Pain Link Helpline
1300 340 357 (Monday – Friday; 7am – 7pm AEST)

Chat to Reconnexion about getting help with Benzodiazepines
1300 273 266 or info@connexion.org.au (Monday – Friday; 9am – 5pm AEST)