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Last year some of our members kindly contributed to a study carried out by the University of Strathclyde on behalf of HIS (Healthcare Improvement Scotland). This study aimed to explore the advice and support offered to patients by pharmacists taking common painkillers known as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs eg. ibuprofen, naproxen). They were particularly wanting to find out if a newly developed NSAID toolkit provided to community pharmacists had made any impact on the advisory practices. The overall aim is to improve patient safety.

The study is now complete and here are some of the their findings:

Staff Insights

  • Staff using the toolkit are more likely to use the practical resources (such as the till prompts or stickers).

  • Staff who have used the Toolkit report their confidence has increased. Also the amount and quality of their advice they offer has improved.

Insights from those collecting or purchasing NSAIDs

  • There is variation in the delivery of NSAIDs information and advice across community pharmacies.

  • When people do receive advice around NSAIDs safety they find this helpful.

  • People who have been given advice say they are more likely to go to a pharmacy for advice in the future.

Calderside Medical Practice in Lanarkshire has moved from treating persistent pain as a symptom that needs a drug to treating it as a long-term condition that can be managed with information and support.

Since changing their approach in 2016 they have registered around 300 patients with pain and have halved their prescribing of both opioid and gabapentinoid medicines. Patients at the practice find they need to attend GP surgeries less frequently since they have benefitted from rehabilitation through pain management consultations with access to multi-disciplinary support.

Dr Kieran Dinwoodie, one of the doctors at Calderside Medical Practice, gives his perspective on this approach.

Consultation Model

My consultation model is based on building trust. This means my patients have to feel heard, validated and supported. This helps move the conversation on from ‘what’s the matter’ through to ‘what matters to you?’

First Consultation

At the first consultation there are often multiple problems and high emotions. It is not possible, or fair, for the patient (or for me!) to try and manage this in ten minutes.The goal is to build a relationship, not fix a problem. I start with the biomedical assessment to make sure there are no indications of underlying problems that need to be investigated. I also check if there are active mental health problems. The next step is to be honest and let the patient know there is no magic tablet, and that this is a long-term condition in its own right. I explain that I will work with the patient to improve their quality of life. At the end of the first consultation I tell the patient about the practice website which has lots of clear, easily-accessible resources offering information and support. We then follow up in around one month.

Follow Up

At the follow up consultation, I focus on the pain management plan and especially goals for what the patient wants for themselves. At this point we also discuss medication options. This might mean screening for neuropathic pain, and ensuring any medication is appropriate. Also, if there are associated mental health problems, I discuss appropriate medication that might be helpful.

Support

Many people need more support than their GP can offer. Having access to skilled practitioners and voluntary organisations helps improve outcomes. The key is trust and for people to feel supported. Our occupational therapist helps our patients improve their daily functioning and our pharmacist helps with supported opioid and gabapentinoid reductions.

Multidisciplinary Team Flow Chart
More Information
A headshot of Dr Mick Serpell.

Dr Mick Serpell, Consultant in Anaesthesia & Pain Medicine for Greater Glasgow & Clyde NHS

Let me explain, I work with patients who have chronic pain. My journey as a novice in the triathlon world required me to make changes in my beliefs and behaviours.

Changes very similar to those required by patients with chronic pain, who wish to regain some form of ‘normal’ life after all available treatments have been tried and failed. This rehabilitation is usually done through a process called a ‘pain management program’

It all started with my first ever triathlon event, just off Oban in August 2013. The ‘Craggy Island’ triathlon involves a small swim (550m) from the mainland to Kerrera Island, then a 14K mountain bike ride, followed by an 8K cross-country hill run. The short swim distance was what attracted me, as I could not swim more than two lengths of a pool without gasping for air. Swim training started six weeks before race day. Slowly I built up my tolerance to twenty-two pool lengths. I was ready, right?

Wrong! A sea swim is completely different from a pool swim. Cold and choppy is the water, and you can’t see what lurks below! It was a memorable introduction for me to the world of open triathlon – nearly drowning on three occasions.

However, I made it to shore and crawled into the transition area for the bike phase. As I warmed up and established a rhythm in the running section, I clawed my way up (literally on some of those hills!) to finish in just over 2 hours.

Contemplation

I had survived! Feelings of immense satisfaction and disbelief hit me at the same time. And, rather strangely, I had enjoyed myself. If I were to do this again, though, I would need to be much, much better prepared .

Making plans

Over the next two months I pondered. I read a book on triathlon training (Be Iron Fit by Don Fink), focusing particularly on time management (Preparation). Could I devote the time required? I decided to bite the bullet and booked a triathlon event as late in the 2014 season as possible (Goal setting) in order to avoid starting the 30-week training programme until well after the Christmas holidays – I enjoy my food and drink a little too much (Boom and bust).

Training

Training started in January 2014 with the ‘5K challenge’, which a group of friends were doing after the festive indulgences (Action). The challenge is to run 5K every day for the whole of the month. It is a real test of commitment to do it every single day, for 31 consecutive days, especially during that dark and miserable month. On some days the run was done at 4 AM before going to the airport or at 11:30 PM after a busy day on call. But I completed the challenge and knew then that the task was possible.

Goals

I had never intended to do a full Ironman. I booked it as there was no other triathlon event late enough in the season that didn’t clash with holiday or business trips. I naïvely thought that doing the training for a full Ironman couldn’t be much more effort than training for a half! My 30-week schedule factored in practice events such as a Standard (Olympic) distance triathlon. These revealed my weaknesses (fitness, technique and equipment) and gave me specific areas to focus on (how to fix a flat tyre mid-race, how not to forget to bring a wetsuit and have to borrow one two sizes too small!). Completing these events also gave me confidence that the big race was achievable.

Taking Part in Ironman Wales

Sea swim (2.4 miles), bike ride (112 miles) and marathon (26 miles) all in one day!

So the big day finally arrived, much quicker than expected. I would like to share what I think are two important lessons from my Iron Man.

Lesson 1 – Preparation

The closer I got to the event, the more I realized that mental preparation was absolutely essential before the race. So, I drove down straight from work (4 hours sleep in Cardiff) to arrive in Tenby on the Friday morning for the first practice swim.

There was a sea swell of up to two feet. I spent the next two mornings just getting familiar with the conditions. Thanks to my practice sessions in Scottish waters, cold water temperature was not an issue. On race day (Sunday) the swell did not look so bad when we started at 7 AM. It soon picked up – many were seasick and vomiting, over a hundred swimmers were pulled out and the swim stage was very nearly cancelled.

I was not ignorant of these facts as I was either being tossed up in the air by waves or buried under them in an avalanche of water. I didn’t try to fight the conditions; I was relaxed and calm and accepted them (mindfulness). The next day in my hotel, I met a seasoned Ironman who said he had never experienced such rough waves and did not finish the swim. I strongly believe that without those two preparation days, I would not be writing this story in quite the same way.

Lesson 2 – ‘Pace and Graze’

This is common knowledge amongst competitors, but putting it into practice can be difficult. The temptation is to fire off and chase the others in the bike section. If you do, then it’s more than likely you will hit the ‘wall’ towards the end, as you may not have enough fuel in the tank. The bike section is where you do most of your eating and drinking because it’s harder whilst running.

Usually, it is a matter of getting into a steady bike pace and start consuming! But, after THAT SWIM, the nausea put paid to oral intake for nearly an hour. It is hard holding back on the pace, but it returns dividends later when you can gradually increase momentum and reel in those riders who went off too soon.

To the end

To reach the marathon section was a relief – barring an accident, I would complete. I knew that I could jog, shuffle, walk or even crawl a full marathon if I had to. I ran the first 10K, then did a mix of walking uphill and shuffling on the flats and downhill. All the while the enthusiastic crowds lining the streets kept us all going. Their encouragement and genuine support was immense. It can never be overstated just how much it means to have people recognize and acknowledge the pain and effort you are struggling with.

Summing Up

After completion those same feelings of immense satisfaction and disbelief which I had experienced at Craggy Island hit me again. Tenby was a fantastic experience, which I will remember forever, and one that I would recommend everyone to try. I will definitely repeat it again, but for now I’m enjoying the rest. This is a luxury that pain patients don’t have. Will I relapse? Who knows? I’m only human. But I have a program, which I can now follow. It’s up to me and it’s my choice whether I reach termination.

If you would like to find out more about raising money for Pain Concern (not necessarily involving extreme physical exertion!), visit our fundraising page.

This is an excerpt from Pain Matters 61

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