Pain

This webkit has been built to bring together all the PrescQIPP resources on pain management and review. We have also included and signposted to other resources available.

If you have resources you would like to share with the PrescQIPP community then please get in touch.

General resources

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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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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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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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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B62: Tramacet®

This bulletin focuses on Tramacet® (paracetamol 325mg/tramadol 37.5mg) and provides the rationale for new patients to be initiated on paracetamol or paracetamol with codeine. Current patients should be considered for a switch to paracetamol alone or paracetamol with codeine. Update coming soon.

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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

Here you will find resources that have been shared via the innovation hub which are all linked below.

Reducing Opiate prescribing in Pain - Great Yarmouth and Waveney CCG

Great Yarmouth and Waveney CCG have recently launched an opiate camping aimed at reducing prescribing of opiates. They have shared their campaign materials with us. Please Acknowledge them if using any of these materials locally.

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GP and Practice Clinical Pharmacist Opiate Reduction Clinic Project (2018)

The project aimed to reduce the number of patients historically receiving high dose opiates (>120mg Morphine equivalent per day) in Practice in line with national Opiate Aware guidance, to reduce patient harm.

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Pain toolkit workshops HSCNI

This project aimed to provide information on pain self-management to patients experiencing persistent pain to assist them to have self-reported better outcomes and improved quality of life. In addition, it aimed to enable HCPs (healthcare professionals) involved with patients using analgesia to provide a consistent message regarding pain self- management.

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Back pain pathway Mid Essex CCG

The established Mid Essex long-term conditions working group (which consists of consultants and primary care physicians) highlighted acute lower back pain as a condition which required work to develop and manage the treatment pathway and provide better co-ordinated care to patients across the primary and secondary care interface.

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