Exclusive The NHS England clinical director for prescribing has said he no longer refers patients to pain clinics because they end up on even higher strength opioids.
Speaking at Pulse Live, Professor Anthony Avery, who is also a GP and professor of primary health care at Nottingham University, said a different approach with less emphasis on drugs is needed.
He was responding to a question from a member of the audience at the event, who asked how GPs should manage patients who have been put on ever-increasing numbers of painkillers when they have sent them to a pain clinic.
‘I personally have largely stopped referring to pain clinics,’ he said. ‘You write to them and you say “we’re looking for a holistic approach, we’re not looking for an increase in medications”, but often they still end up prescribing higher strength opioids.’
He added: ‘It seems awful that we’ve been almost hoodwinked into believing that they work [for long-term non-cancer pain] for the last 20 years and have carried on prescribing them and increasing the doses of them.
‘In relation to pain clinics, I think we need a different approach with less emphasis on drugs and a more holistic approach which focuses on helping people to live well with pain.’
Earlier this month, guidance from NHS England said GPs should offer alternatives including psychotherapy, sleep clinics and social activities or clubs before prescribing addictive painkillers.
An action plan, published following the 2019 review by Public Health England, which found one in four adults were prescribed medications associated with dependence, including opioids, benzodiazepines and antidepressants, said reducing prescribing required a ‘whole-system’ approach and the development of new services with personalised and innovative support for those at risk of withdrawal or dependence.
But data from NHS England shows GPs and pharmacists have already helped cut opioid prescriptions by 450,000 in under four years.
The framework, which tasks the whole of the NHS with tackling the problem said where appropriate GPs should offer social prescribing, health coaching, peer support as well as psychotherapy before prescribing a potentially addictive medicine.
The framework also asks commissioners to provide services for patients who wish to stop taking addictive medicines.
And it states to help reduce prescribing in the first place: ‘Systems should ensure that alternative treatment options are available and that prescribers are aware of them.’
Regular audits should be done of prescribing for all adult patients to support GPs and clinical pharmacists to provide patients with a personalised review of their medicines and make a shared decision about whether a change in treatment is needed.
NICE guidelines published last year on safe prescribing and withdrawal management for addictive drugs said GPs should provide regular reviews for patients on drugs for chronic pain.
For some a dose reduction rather than complete withdrawal may be a more realistic approach, NICE said and if there is more than one medicine, this should be done in stages.