Poorly managed pain crowds GP surgeries, A&E

Pain is one of the most distressing sensations and one of the most common reasons why people seek healthcare advice.

Managing the biopsychosocial aspects of chronic pain in their entirety are also probably one of the most important reasons for increasing healthcare expenditure.

It is the unseen disability and the cost of human suffering that is not accounted for in most epidemiological studies and statistics.

Poorly managed pain is also a cause of repeated attendances to GP surgeries, A&E and hospital inpatient stay and delayed discharge.

Patients, and to a certain extent, healthcare practitioners, have an expectation to deliver a ‘quick-fix’ to pain-related problems and often there is ‘overmedicalisation’ of complex biopsychosocial problems.

It is easier to prescribe an analgesic rather than listen to complex issues; and it is far easier to arrange for repeat prescriptions than conduct regular reviews.

We are not seeing an opioid epidemic of the magnitude as seen across the Atlantic for two reasons; there is no financial incentive on prescription medicines for physicians and pharmacists here are far more vigilant in ensuring that patients are not getting multiple prescriptions and are taking medicines as prescribed.

The current provision of Pain Services is limited to a few centres in the country and there is an ongoing programme to try and manage most of these patients in the community.

Engagement

I think there could be a huge role for community pharmacists to be part of this changing landscape on how pain management is delivered.

Most pharmacists do advise patients about their medicines and often pick up signs of side-effects as well as early warning signs of underlying conditions.

The pharmacist is also the safeguarding champion who ensures that drug interactions are minimised and often advises clinicians on suitable options for management.

There are also independent prescribing pharmacists within certain spheres of medicine which holds precedence for pharmacists to be independent practitioners. There are pharmacists holding regular clinics and the government is encouraging pharmacists to be the first port of call for minor ailments.

There is increased awareness amongst healthcare professionals as well as policy makers that social prescribing and supportive care are more important than medical management for chronic illnesses including persistent pain. Opportunity There is an opportunity for pharmacists to work alongside pain specialists and GPs to help deliver better quality of pain management and enhance the patient experience.

One of the biggest challenges faced by a person in pain is to get access to an appropriate healthcare professional who can give them advice and possibly, suitable treatment.

Pain is unseen disability

Even after waiting for a period of time and after meeting with a pain specialist and a management plan being put in place, most patients would like to be reassured about their medicines and undesirable side effects should be dealt with promptly; this might even mean that the initial medicines would have to be substituted.

Again, waiting for a GP appointment is often a frustrating experience.

In my opinion, there is plenty of potential to explore the possibility of having trained pharmacists with a special interest in pain management to take on the role of the “most suitable and accessible healthcare professional.”

Additionally, they would continue to be in the best position to challenge the continuing use of opioids and other medicines that have the potential to develop tolerance and dependence in the management of chronic pain.

Collaboration

This collaboration between pain specialists, GPs and pharmacists would enable successful delivery of better patient care within the current limitations of an overstretched healthcare system in the UK.

The British Pain Society is the multidisciplinary Society representing healthcare professionals involved in Pain Management in the UK.

The membership mainly consists of doctors, nurses, physiotherapists, psychologists and scientists involved in pain research.

Traditionally, pharmacists have not been members of the society despite having excellent working relationships with the British Pharmacological Society.

But an improved collaboration between pain management specialists and pharmacists will only result in the creation of a better working arrangement for patient benefit. We should look at educational events that are mutually benefi cial and work together in developing policies for managing patients with chronic pain.

The British Pain Society is committed to looking at training programmes specifi cally suited for pharmacists to help and support them in their clinical practice. Further information on the activities of the British Pain Society can be found on our website (www. britishpainsociety.org).

Dr Arun Bhaskar, who wrote this article, is president of The British Pain Society

This article also appears in the August issue of Pharmacy Business.

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