Airing Pain 137: Pharmacists and Chronic Pain

How to Prescribe and De-prescribe Safely

This edition of Airing Pain was prompted by the 2022 NICE Guidelines which follows a Public Health England report (2019) looking at medicines associated with dependence and withdrawal. This new legislation follows increased concerns in high levels of prescribing.

This edition discusses the challenges and opportunities of de-prescribing; and poses a shift in focus towards supported self-management and de-medicalising the management of pain for some patients. By this we mean the exploration of alternative therapies and supported self-care customised to individual needs, which come hand-in-hand with any de-prescribing of medicines.

We discuss the incredibly important role of the advanced pharmacist practitioner in adjusting the prescriptions of medicine, and the long-term regular use of pharmacists for these purposes.

Contributors:
Dr Emma Davies, Advanced Pharmacist Practitioner specialising in Pain Management

Dr Keith Mitchell, Consultant in Pain Medicine at the Royal Cornwall Hospital

Dr Jim Huddy, GP and Clinical Lead for Chronic Pain

Special Thanks

This edition of Airing Pain was possible thanks to support from the British Pain Society.

Time Stamps:
0:49 – Paul introducing the topic NICE Guidelines 2022, following from a Public Health England report 2019 looking at medicines associated with dependence and withdrawal.

1:38 – Introducing Dr Emma Davies; advanced pharmacist practitioner in pain management, Co-Founder to Living Well With Pain, prescribing for chronic pain, and involved in setting NICE guidelines.

2:46 – Discussing risk-benefit of prescribing an increasing dose of pain management medicines.

6:23 – The problem: knowing the medicines may be harmful but a lack of correct support in place for other ways of living with pain. Reducing this type of medicine must come hand-in-hand with proper support to living well with pain.

7:24 – What does support look like? Alternative therapies and support based on their personalised circumstances.

9:15 – Talk from the Patient Group at the British Pain Society on intersectional problems and barriers to accessing care particularly for socially minoritized individuals and groups.

9:58 – The importance of personalised pain management and how to address this from the perspective of a Pharmacist Practitioner

12:00 – Discussion of possible criticisms of NICE Guidelines

13:28 – Introducing the educational resources Pain Consultants Dr Keith Mitchell and Dr Jim Huddy, at Royal Cornwall Hospital, have put together for prescribers.

14:12 – Introducing Dr Frances Cole’s 10 footstep model to pain management as another possible alternative to prescribing.

15:10 – Personalised care for each patient and supported self-management.

16:26 – Social prescribers and upskilling non-clinicians to provide the support needed towards de-medicalising the management of pain for some cases.

17:27 – Discussion on how to pose non-medical supported self-management to patients, in place of medicalised support. 

17:49 – Explaining the Pain Café in Cornwall; the benefit of belonging to a peer group outside of typically medicalised spaces, and the power of sharing challenges and experiences in a common location or setting. 

20:00 – Invitation to leave feedback.

20:45 – Advanced pharmacist practitioner, Dr Emma Davis, on the diverse and essential roles pharmacists play in pain management.

21:40 – Introducing the ‘medication review’.

24:18 – Exploring the concept of reaching the limit of helpfulness with multiple cross-over medicines. Thinking about making small reductions in prescribing.

25:52 – Dependence forming medicines as part of the structured medical review, in England.

28:48 – The ‘healing power of a good book’: escapism techniques.

More Information:

Referenced Edition 123: Dr Jim Huddy Royal Cornwall Hospital, in ‘Opioids and Chronic Pain’

The Pain Café in Cornwall

Imagine If – Social Prescribing Team

NICE Guidelines (2022) ‘Medicines associated with dependence or withdrawal symptoms’

Living Well with Pain – Ten Footsteps Programme