Prescribing wellness: comprehensive pain management outside specialist services

Opioids have important roles in the time-limited treatment of acute and cancer pain, end-of-life pain or dyspnoea, and in opioid dependency. Maintaining focus on biomedical treatments, including drugs, has limited success in chronic pain. Active self-management and healthy lifestyle choices are fundamental to addressing multisystem complexity and harnessing neuroplasticity in chronic pain. Addressing psychosocial maladaptations and physical deconditioning requires a variety of approaches, frequently involving multiple care providers. In practice, most pain care is delivered outside specialist centres by GPs and other non-pain specialists. Although they are well placed to provide multimodal care, they often lack training and confidence in delivering this care.