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 followed a Public Health England report (2019) looking at medicines associated with dependence and withdrawal. Read transcript 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 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. 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. 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. 16:26 – Social prescribers and upskilling non-clinicians to provide support. 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 20:00 – Invitation to fill in our survey 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’. 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

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