Imagine waking up and feeling like the same ache from yesterday will follow you again, every day, without pause. That’s life for people living with chronic pain. It’s invisible, yet it reshapes routines, emotions, even relationships. The numbers are staggering—according to the 2023 New Zealand Health Survey, about 1.2 million Kiwis live with some type of persistent pain. That’s nearly one in four adults. Behind every statistic, there’s a person desperately searching for something, anything, to feel better.
What Is Chronic Pain and Why Is It So Complicated?
Chronic pain isn’t just pain that sticks around for a while. Doctors say if it lingers for more than three months, it’s chronic. Sometimes it starts after an injury that never quite heals. For others, it shows up without a clear cause—arthritis, nerve injuries, old back sprains, migraines, fibromyalgia, endometriosis, and even cancer can all lead to long-term pain. While pain has a job (it’s your body yelling when something’s wrong), chronic pain is like the fire alarm stuck in ON mode, even when nothing is burning anymore.
The real headache? It often won’t completely disappear, even with medical care. What works for one person might do nothing for another. This is partly because of how pain messages jump from nerves to the brain, mixing with mood, memory, and sleep. Stress, anxiety and depression can crank up the pain dial. That’s why doctors don’t just hand out a single prescription and send people home. Chronic pain takes a team effort—sometimes with medicines, sometimes with therapy, always with trial and error. The ultimate goal: less pain, more life.
Prescription Medications: What Doctors Use (and Why)
Most folks think "painkiller" and picture a bottle of strong pills. It’s not always that simple. Here’s what doctors actually reach for:
- Paracetamol (Acetaminophen): You’ll know it as Panadol. It’s usually the first stop, especially for osteoarthritis or mild muscular aches. It’s easy on the stomach, but big doses can hurt your liver. Some studies say it works only a little better than placebo for chronic pain—but for a lucky bunch, it makes a difference.
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Think ibuprofen (Nurofen), diclofenac, or naproxen. These help when the pain comes from swelling or inflammation (like arthritis). They’re more effective than paracetamol but can upset your stomach, raise blood pressure, or harm kidneys with long-term use. Doctors often suggest using them short-term or at the lowest possible dose.
- Opioids (e.g., codeine, oxycodone, morphine): These are heavy hitters, prescribed with caution. Why? Opioids work well for severe pain after surgery or advanced cancer, but for most chronic conditions, they lose effectiveness over time. There’s also a real risk of addiction or serious side effects like constipation, sleepiness, or even respiratory depression. In New Zealand, opioid scripts are tightly regulated and usually reserved for the toughest cases, and never as a first-line answer for chronic pain.
- Antidepressants: Surprising, right? Certain antidepressants like amitriptyline or duloxetine are used for nerve pain (neuropathy), fibromyalgia, or chronic headaches—even when there’s no depression. These drugs help calm overactive nerves and can also lift mood, which is a bonus since depression and pain often travel together.
- Anticonvulsants: Medications like gabapentin and pregabalin were created for epilepsy but are stars in treating nerve pain. They can dampen electrical pain, like what you might feel with sciatica or shingles. Not everyone gets relief, and some feel dizzy or drowsy, but these medicines often open doors when nothing else works.
- Topical solutions: Creams with capsaicin (yes, from chilli peppers) or lidocaine patches can be spread right where it hurts. These work for joint pain, nerve pain, or sore muscles—and because they’re put directly on the skin, the rest of your body skips most of the side effects.
The trick with all these drugs is balance—enough for relief, not so much that side effects take over your life. More isn’t always better. Doctors usually start with the safest, lowest dose medicines, and only add or swap drugs as needed.
Combination Treatments: Mixing Meds and Beyond
If you’re still in pain after trying one prescription, you’re not alone. Most people end up using a few strategies at once. Think cocktail—not of booze, but of therapies. You might see this called “multimodal” treatment.
- Some pain clinics offer a mix of meds, stretching from paracetamol and topical patches to low-dose antidepressants, with regular check-ins to tweak the mix.
- Physical therapy is nearly always part of the package. A physio might show you exercises to strengthen muscles, realign posture, or simply get moving again, since being still usually makes pain worse in the long run.
- Lifestyle changes really do matter—less sugar, more vegetables, as little processed food as possible, and keeping active. It’s not instant, but it adds up. One meta-analysis found that regular low-impact exercise reduced pain intensity by up to 30% in people with osteoarthritis. Even swimming or a gentle walk can help.
- Injections have their place. Doctors sometimes inject corticosteroids around nerves or inside joints for quick relief that can last weeks or months, though the effects wear off and there are limits to how often these can be safely used.
- For nerve pain, TENS (Transcutaneous Electrical Nerve Stimulation) machines—tiny, battery-powered devices that zap sore spots with a mild tingle—are finding a loyal Kiwi following. The evidence is mixed, but they’re drug-free, fairly cheap, and worth a go for some people.
One essential truth: there’s rarely one magic answer. It’s about mixing, matching, and being patient while your team figures out what works for you.
Non-Drug Therapies on Prescription
Don’t dismiss non-drug options as “soft” medicine. Many are as strongly recommended by guidelines as any script might be. Here’s what’s making waves:
- Psychological therapy: Pain and mood are linked, and tools like cognitive-behavioural therapy (CBT) or acceptance and commitment therapy (ACT) can teach your brain new ways to handle distress. CBT, for example, has a mountain of research showing it can cut pain scores and improve daily functioning.
- Mindfulness and meditation: Auckland District Health Board has added mindfulness courses for patients with refractory pain. One local pilot study found weekly two-hour mindfulness group sessions dropped pain scores by 25% over three months and boosted quality of life.
- Acupuncture: Originating from China, acupuncture is now offered in many hospitals and pain clinics around New Zealand. Some scientific reviews suggest it can help with specific conditions like tension headaches, migraines, or osteoarthritis, though results vary.
- Occupational therapy: Pain often steals the joy from daily routines. OTs (occupational therapists) focus on restoring energy, pacing activities, and helping people keep doing what matters—from making dinner to playing with kids. I know from experience: When my daughter Liora saw me start using pacing tricks, she realized mum’s not lazy, just smart about pain.
It’s all hands on deck—meds, movement, mindfulness. This layered approach is what doctors now call the “biopsychosocial” model—acknowledging that pain is never just physical or mental, but both, tangled up.
Known Risks, Myths, and Finding a Sustainable Plan
It’s tempting to reach for the strongest drugs, but that’s not always a winning move. Here are a few common misconceptions, risks, and things to watch out for:
- Opioids aren’t a cure-all: They bring serious risk of dependence and accidental overdose, especially when combined with alcohol or other sedating meds. Ministry of Health data show opioid prescriptions in NZ have dropped by 30% since 2018, as safer chronic pain options gain ground.
- Addictive potential—even with mild painkillers: Not everyone knows that codeine, found in some over-the-counter combos, can still lead to dependence if used too often or for too long.
- Magic-bullet thinking: Probably the biggest myth. Chronic pain is sneaky, and most “miracle cures” just don’t work for everyone. Real progress is usually a slow, bumpy ride.
- Alternative medicines: Oils, herbal supplements, and “miracle” devices are everywhere on Facebook groups and TikTok. While some people swear by turmeric or CBD oil, evidence is mixed and these aren’t prescriptions in New Zealand. GPs typically stress choosing proven options first before exploring the unknown.
Tackling chronic pain sometimes feels like being a detective, always looking for what helps and what makes things worse. It’s worth tracking symptoms with a diary to spot patterns—foods, weather, stress, lack of sleep, or particular activities that tip the scale. Bring this info to your doctor; it can make finding the right treatment plan way easier.
| Pain Prescription | What It’s Best For | Common Side Effects | Notes |
|---|---|---|---|
| Paracetamol | Mild-moderate pain | Liver injury (high dose) | Check total daily dose |
| NSAIDs | Arthritis, muscle pain | Stomach, kidney, blood pressure | Use lowest effective dose |
| Opioids | Severe or cancer pain | Addiction, drowsiness, constipation | Short-term use, careful monitoring |
| Antidepressants | Nerve pain, fibromyalgia | Drowsiness, dry mouth | Used in lower doses than for depression |
| Anticonvulsants | Nerve pain | Dizziness, drowsiness | Start low, go slow with dosing |
If there’s anything I wish people realized: getting through the day with chronic pain isn’t about chasing an end to all discomfort. It’s about finding a mix—of medications, movement, and mental strategies—that gets you more good days. There are flare-ups, weird side effects, and setbacks, but there’s also hope, especially as new treatments and insights keep arriving. Remember, you don’t have to be stoic or tough it out alone. Ask questions, push for help, and keep experimenting until you find what fits for you.