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GPs more cost-effective than hospitals with RA

GPs are ignoring safety warnings and prescribing 'potentially inappropriate' medication to patients with neuro- pathic pain, researchers warn.

Their study of UK general practice raised particular concerns over use of amitriptyline, with preclusions ignored or overruled in almost half of patients on the drug.

Prescribing experts warned that training in chronic pain was 'appalling' and that GPs were faced with limited medication options and long waiting lists for pain clinics.

The research, to be presented at next week's European Federation of Neurological Societies conference in Athens, Greece, found 47 per cent of 13,436 patients prescribed amitriptyline for neuropathic pain had one or more preclusions to the drug.

In a third of cases there

was potential for drug interactions.

A companion analysis of 39,256 elderly patients with neuropathic pain found 29 per cent were receiving 'potentially inappropriate' medications, most commonly amitriptyline and benzodiazepines.

Dr Brian Crichton, a GP in Solihull, Birmingham, and honorary fellow in therapeutics and pharmacology at the University of Warwick, said: 'There are a number of factors that need to be addressed. Medical school and postgraduate training is appalling in pain management.

'There's an issue of options and waiting lists for pain clinics are very long. You can either leave patients in limbo or use tricylics, but we do have to be vigilant.'

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