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How should we approach prescribing for persistent pain in primary care?

02 December 2023
Volume 5 · Issue 12

Patients with persistent pain often have a history of taking multiple medications with limited benefit. Patients (and clinicians) may also have unrealistic expectations of analgesia.

Recent National Institute for Health and Care Excellence (NICE) guidelines for the management of chronic pain have left GPs with limited medication options (NICE, 2021a). This has further complicated already challenging consultations. The intention of this article is to suggest five principles that can be applied to prescribing for all persistent pain in a primary care setting. This provides a framework for sustainable, patient-centred interactions that meet the needs of both patients and clinicians.

Shared decision making is crucial to the pharmacological management of persistent pain. This involves discussion about risks, benefits and potential consequences to facilitate formulation of a plan that is acceptable to both patient and clinician (NICE, 2021b).

The medications offered to patients with persistent pain are not curative, are unlikely to provide more than 30–50% relief from pain and often help only a minority of people. However, a large number of patients will experience side effects and, once started, are likely to continue to take these medications even in the absence of any benefit (NICE, 2021a). Helping patients understand the risks and benefits of analgesia for chronic pain has clear benefits. Discussing options with patients improves safety, and is also associated with higher patient satisfaction, adherence and perceived practitioner empathy (Weiss et al, 2015).

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