Pain is a symptom or condition that many prescribers come across in their daily scope of practice and many of them are faced with the challenges of prescribing in patients with chronic pain. It has been known for some time that a holistic approach to managing pain is more beneficial than viewing the use of analgesics as the only option and that many people live with ongoing pain despite analgesic prescriptions. This may be why a recent BBC news headline caught my eye, Chronic Pain: The ‘unbearable’ condition affecting one in four, along with the comment that experts state that current chronic pain treatments are failing millions (Clegg and Hughes, 2022).
These experts are leading clinicians in pain management including Dr Cathy Stannard, clinical pain lead for the National Institute for Health and Care Excellence (NICE). One of the analgesics under discussion is the familiar group of opioids. It seems that despite NICE (2021)guidance recommendations that chronic pain should not be treated with opioids or even paracetamol, a BBC IPSOS survey found that almost a quarter of those questioned who lived with chronic pain revealed that they are currently prescribed opioid medications. The survey of more than 4000 adults aged between 16–75 years was carried out by IPSOS on behalf of BBC News (Clegg and Hughes, 2022) and there is the suggestion that up to 25% of the UK population are living with chronic pain. As a result of the findings, pain specialists warn that the NHS is leaving millions of people with chronic pain struggling to get the support they need. This is a result of overwhelmed healthcare services not offering interventions at the forefront of the science but relying on older and outdated treatment options, many of which include opioids.
It is well known that opioids are effective analgesics in certain circumstances, for example in the management of short term and/or acute pain situations, but evidence suggests that their use in long term and/or chronic pain has little benefit. Despite this evidence, opioid prescribing has continued to grow, leading the Medicines and Healthcare products Regulatory Agency (MHRA) in 2020 to issue warnings about the increased use of the drugs and the increased risk of promoting dependence and addiction (MHRA, 2020).
The BBC survey found that more than 40% of people who were currently prescribed opioids for chronic pain had been taking these medications, with variable amounts of pain relief, for more than 5 years, so before the MHRA warning was issued. People with chronic pain need the support of a multidisciplinary team, which includes GPs, physiotherapists, psychologists and pharmacists and the treatment regimen should not just be drugs. Dr Stannard takes time to stress that the suggestion is not to remove medication but to consider adding in other options, including exercise, physical therapies, acupuncture, psychological therapies and support groups.
I know many of you will read this BBC survey with interest and follow up with an exploration of what other pain services are available in your area. It is important to not just do what we have always done, but to seek out the new frontiers and always put our patients at the centre of everything we do.