Management of chronic pain

Reproduced from Quality Prescribing for Chronic Pain – A guide for improvement

 

The Scottish Government, in collaboration with NHS Scotland,  has produced a guide on the Management of Chronic Pain which includes both pharmaceutical and non-pharmaceutical interventions in the management of chronic pain. The prescribing for people with chronic pain is clearly defined in SIGN 136. NICE have also produced a number of guidelines on management of chronic pain. However, clinicians in NHS Scotland should refer to SIGN in the first instance which remains the only comprehensive evidence based guideline for managing chronic pain in the non-specialist setting.

 

Why is this important?

1 in 5 people in Europe suffer from chronic pain which is comparable to the proportion of the population suffering heart disease, diabetes and major depression combined. 1 in 20 people in Scotland suffer severe, disabling chronic pain.24 Prescribing for chronic pain increased by 66% over the ten years from 2006

Key Principles

There are a number of key principles which should be considered as part of the management of chronic pain:

  • Chronic pain is a condition which is individual to the patient and any therapeutic management plan needs to place the patient at the centre. The approach should be based on assisting the patient to achieve goals which have been identified in partnership with the prescriber
  • Goals of therapy should be decided in a partnership with the patient adopting the what matters to me principle
  • Prescribers should work with patients to develop an understanding of the importance of self-management and non-pharmaceutical approaches to the successful achievement of goals. Patients should be aware that therapeutic options which do not involve medicines, or which are offered in conjunction with prescribed medicines, may result in better achievement of goals and result in less harm than the prescription of medicines alone
  • Prescribers should work with patients to develop their understanding of chronic pain, how it differs from acute pain and the impact this may have on goals of therapy . Difficult and honest conversations may be required to establish an understanding with the patient that it is highly unlikely that the therapeutic management plan will result in full resolution of their pain symptoms (>30%), but it may assist them with coping
  • Assessment Treatment pathways for chronic pain are available on the SIGN website
  • A robust plan for ongoing review of treatment should at the centre of care for every patient
Problems with Pharmacological therapies

There is increasing evidence that many analgesics, including opioids, gabapentin and pregabalin, have the potential for harm and abuse. Cases of dependency have been described and there are reports of an increasing street value risk of drug misuse.26 27 28 There are a number of pharmacological therapies available for the management of chronic pain.

Recommendations
  • Follow a clinically appropriate approach to initiation of analgesia, discussing expectations, risks and benefits and incorporating agreed criteria for stopping or continuing medication
  • Review effectiveness, tolerability and compliance on an on-going The burden of medicines should be reduced where possible. Electronic tools to assist with this are currently under development and  will be hosted on the Effective Prescribing and Therapeutics website
References

See this link for Quality Prescribing for Chronic Pain – A guide for improvement