title: Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial.
abstract: OBJECTIVE
  To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.
  
  
  METHODS
  An exploratory randomised controlled trial.
  
  
  METHODS
  Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).
  
  
  METHODS
  Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. RANDOMISATION AND INTERVENTION: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.
  
  
  METHODS
  Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.
  
  
  RESULTS
  In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).
  
  
  CONCLUSIONS
  This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.
  
  
  BACKGROUND
  www.isrctn.org/ISRCTN06131530. Medical Research Council funding.
authors.affiliation: Health Services Research Unit, Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK.
authors.forename: Hanne
authors.initials: H
authors.lastname: Bruhn
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bond
authors.forename: Alison M
authors.initials: AM
authors.lastname: Elliott
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hannaford
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.forename: Paul
authors.initials: P
authors.lastname: McNamee
authors.forename: Blair H
authors.initials: BH
authors.lastname: Smith
authors.forename: Margaret C
authors.initials: MC
authors.lastname: Watson
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
authors.forename: David
authors.initials: D
authors.lastname: Wright
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