Pain

This page will bring together all the PrescQIPP Pain resources. Each set of resources includes tools that can be adapted for local use before implementation.

General resources

B164: Controlled drugs monitoring

The controlled drugs bulletin and resources have been written to support CCG teams that have a role in supporting the regional NHS England Controlled Drugs Accountable Officer (CDAO).

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B119: Neuropathic pain

These resources support the implementation of NICE clinical guidance on neuropathic pain and also review of patients taking medicines for neuropathic pain, some of which are high risk medicines. Update coming soon.

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B149: Non-neuropathic pain

These resources support treatment review and understanding the place in therapy of different pain treatments. Supporting resources include an audit, treatment pathway and patient information and contracts for controlled drug/opiate use.

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Different classes of drugs used in pain

This section addresses some of the safety concerns and clinical concerns associated with the different classes of medicines used in pain.

B218: Reducing opioid prescribing in chronic pain

These tools can be used in conjunction with the High dose opioids audits tools to support review and reduction in high dose opioid prescribing.

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B215: Opioid patches

This bulletin focuses on the safe and appropriate prescribing of opioid patches as well as cost effective treatment choices. An audit is available to help support the review of patients already prescribed opioid patches to assess whether there is a continued need for treatment with patches.

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B213: Oxycodone

This bulletin reviews the place in therapy of oxycodone and offers guidance and support material for organisations considering reviewing oxycodone prescribing.

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B96: NSAIDs

This bulletin and supporting resources look at the risks associated with long term treatment of NSAIDs. There are long-standing and well-recognised GI and renal safety concerns with all NSAIDs. There has also been an increase in CV safety concerns with NSAIDs. Therefore the substantial use of NSAIDs needs addressing.

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High dose opioids audits

The set of audit tools linked below were developed by the NHS England East of England CDAO network to support practices and community pharmacists review and tackle high dose opioid prescribing.

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Opioids aware webinars

These three webinars were delivered by Dr Ruth Bastable to launch and update on the opioids aware audit that was first launched and run in the East of England.

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Opioid management of pain in secondary care

We welcomed Dr Mark Abrahams, Clinical Director of the pain service at Cambridge University Hospitals NHS Foundation Trust, who examined the role of opioids in the management of chronic pain conditions.

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Items of low clinical value

Many of these resources support the implementation of the PrescQIPP DROP list and the NHS England “items which should not be routinely prescribed in primary care guidance.

B194: Co-Proxamol

This bulletin discusses the use of co-proxamol and supports reviewing and discontinuing prescribing in patients still taking this unlicensed medicine. It supports the implementation of the NHS England items which should not routinely be prescribed in primary care guidance.

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B132: Fentanyl immediate release

This bulletin focuses on fentanyl immediate-release formulations and provide the rationale for new patients to be commenced on immediate-release morphine, and for current patients to be considered for a switch to immediate-release morphine or have their therapy reviewed and stopped where appropriate.

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B208: Paracetamol and tramadol combination products

This bulletin focuses on Paracetamol and tramadol combination products and provides the rationale for new patients to be initiated on paracetamol or paracetamol with codeine.

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B56: Targinact - Oxycodone/Naloxone

This bulletin and resources provide further information on the evidence base for for using oxycodone/naloxone prolonged release tablets, the rationale to stop treatment and also suggests alternative treatment options. Update coming soon

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B205: Glucosamine

This bulletin reviews the use of glucosamine (with or without chondroitin) preparations. Guidance on stopping treatments and patient information is available to support implementation.

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B114: Rubefacients

This bulletin supports the PrescQIPP DROP list. It reviews the place in therapy of the rubefacients which also have a nice do not do attached to them. An audit and patient letter are available as supporting tools.

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Data

The data and analysis section of the website has a range of data which will help commissioners identify variation in practice and spend and savings that may be available through implementing different projects. All our current bulletins have visual data packs available which are on the same webpage as the resources. This section shows the extra resources we have available to support review of pain prescribing.

Pain visual snapshot

Updated monthly, containing latest 12 months data and grouped to two levels of pain specific areas within the BNF, this clinical snapshot reports at both commissioner and practice level (visualisation only).

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Controlled drugs thresholds visual snapshot

The controlled drugs thresholds snapshot and visual analytics is designed to support monitoring of the different schedules of controlled drugs at a local level, and offer comparisons at a national level.

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Shared good practice - Award winning project webinars

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