The use of opioids and other dependence forming medicines for non-cancer pain is associated with increased risk of harm and has limited evidence of benefit. The North East and North Cumbria ICB (NENC ICB) region is the highest in England for prescribing of opioids and gabapentinoids, and County Durham has historically been one of the highest areas within the region. Although prescribing for both opioids and gabapentinoids in primary care has been continuously reducing we still remain high above the national.
A regional report about high prescribing across NENC ICB area in May 2021 concluded that "further interventions in prescribing alone will have limited additional impact and a change in culture and behaviour is required across the system." It was felt to be essential that all stakeholders from the health and social care and indeed wider, system are involved in addressing the underlying causes of opioid and gabapentinoid over-prescribing, and any links to why prescribing is higher in areas of greater deprivation.
In response to this a system-wide advisory group was set up as a sub-group of the County Durham Care Partnership Executive Committee to bring together interested stakeholders from across County Durham to discuss pain management and prescribing, and to ensure a consistent approach to pain management across the County. The group had representation from Community and secondary care Pain teams, Commissioning and Medicines Optimisation (MO) teams, Public Health and local County Council, Police, Prisons, Addiction services and the local Mental Health Trust, and Patient representatives.
The group discussed the current management of patients with non-cancer pain in County Durham, the role of the multi-disciplinary team across the system and non-pharmacological management in-line with relevant national evidence and guidance. It looked at what could be improved and where changes should be made.
As a culmination of this discussion and review the County Durham Pain Pathway was developed, along with associated resources to support clinicians across the system to ensure appropriate setting of expectations, patient-centred care and education about pain and medication use to encourage appropriate treatment of pain and reductions in long term medication use. The additional resources and links embedded aim to encourage patient conversations, increase the use of non-pharmacological methods of pain management and improve personalised care.
The County Durham Pain Pathway was launched in March 23 across the whole system, with representatives taking a lead to roll out in their organisation. Feedback has so far been positive, and the working group and pathway has improved cooperation and communication between stakeholders working with patients with pain in County Durham. Evaluation is ongoing, and further work is planned to continue implementation of the pathway and ensure it meets clinician and patient need.
