The use of medication for chronic pain in primary care, and the potential for intervention by a practice-based pharmacist.
OBJECTIVE
The majority of people with chronic pain use analgesics regularly. Ensuring their safe and appropriate use is important. This study aimed to describe patterns of analgesic prescribing in one general practice, devise a method of identifying chronic pain patients from prescribing records, and assess prescribing recommendations made after a pharmacist-led review of analgesic prescribing and identify the proportion of these acted on by GPs.


METHODS
Prescribing records in a practice of 6720 patients were searched and 678 patients were identified as receiving prescriptions for analgesics. 230 were invited to participate and sent a questionnaire, including questions about chronic pain severity, general health and medications used. This was repeated after six months. The pharmacist completed a detailed medication review using information from medical records, questionnaires and personal interviews. Prescribing recommendations were made to GPs.


RESULTS
192 recommendations about safe or appropriate prescribing were made for 86% of participants after records review, 56% being directly related to analgesic use. After 6 months all recommendations had been implemented in 77% of the patients. Few additional recommendations were made after interview. There was little or no relationship with changes in chronic pain severity or general or psychological health.


CONCLUSIONS
We have demonstrated a method of identifying patients with chronic pain in primary care, and the feasibility and acceptability of a pharmacist-led intervention. This is of potential value in primary care, as relevant prescribing recommendations were made for most patients although further research is required to assess these.
McDermott
M Elaine
ME
Pain Management clinic, Aberdeen Royal Infirmary, Aberdeen, UK. elaine.mcdermott@deveron.grampian.scot.nhs.uk
Smith
Blair H
BH
Elliott
Alison M
AM
Bond
Christine M
CM
Hannaford
Philip C
PC
Chambers
W Alastair
WA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017060:Patient Satisfaction; D010595:Pharmacists; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012606:Scotland; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000700:Analgesics