High Risk Medications

Pain that lasts for more than 3 months is known as chronic or persistent pain. It is common and affects between 3 to 5 in every 10 individuals in the United Kingdom (UK). Chronic pain can be caused by an underlying condition (for example, arthritis or endometriosis) and is known as chronic secondary pain. In many cases the cause of the pain is unclear, this is referred to as chronic primary pain.

Pain is complex and many factors can affect or be affected by the pain, including work and leisure time, relationships with family and friends, and sleep. Management of chronic pain would be individualised to each patient, with a focus on self-management and maintaining daily function and quality of life despite ongoing pain.

Many of our patients require high- strength, potentially addictive medication to help manage their pain condition (s). Of concern are the Gabapentinoid medications, which can cause dependence and addiction, particularly when these are prescribed on a long- term basis. As with all medicines for the treatment of chronic pain, Gabapentinoids should be used only as part of a wider management plan.

General practice standards

• If the decision to prescribe a Gabapentinoid is taken after a shared discussion of goals, plans, risks, and benefits, patients may be required to confirm their consent in writing.
• A patient will be asked to sign a treatment agreement that will detail our practice’s expectations when prescribing drugs of dependence. This agreement details the patients’ responsibilities when taking a drug of dependence, any prescriptions issues, advice on taking medications, how we will monitor their care and the standards of behaviour that are expected. This will be stored in the patient medical record.
• Patients may need to acknowledge that their care requirements are complex, and that referral for ongoing care for all or part of continued healthcare treatment may be required. It is our practice policy that patient care is matched with the level of complexity.
• Patients are reminded that we have a Zero Tolerance policy on issues relating to staff verbal or physical abuse. Any threats to staff will result in transfer of your care.

Reviewing your medication

• All patients newly initiated on a Gabapentinoid medication will be reviewed within 2-4 weeks of initiation, pain assessed, and a decision made as to the effectiveness of the drug.
• Patients on a long-term Gabapentinoid will be reviewed every 6 months to discuss slowly weaning off their Gabapentinoid medication. Treatment will only be continued where there is clear on-going evidence of benefit.
• Where Gabapentinoids are ineffective, they will be stopped, even if no alternative is available.

Pain that lasts for more than 3 months is known as chronic or persistent pain. It is common and affects between 3 to 5 in every 10 individuals in the United Kingdom (UK).

Pain is complex and many factors can affect or be affected by the pain, including work and leisure time, relationships with family and friends, and sleep. Management of chronic pain would be individualised to each patient, with a focus on self-management and maintaining daily function and quality of life despite ongoing pain.

Many of our patients require high- strength, potentially addictive medication to help manage their pain condition (s). Of concern are the opioid medications, which can cause dependence and addiction, particularly when these are prescribed on a long- term basis. Evidence has shown that, whilst opioids are effective analgesics for acute and palliative pain, there is no evidence base for long-term pain relief. Therefore, opioid medications (e.g. codeine, tramadol, morphine) have very little benefit in the management of chronic pain and often the risks associated with treatment (such as overdose and dependence) would outweigh any potential benefit.

General practice standards

• If the decision to prescribe an opioid is taken after a shared discussion of goals, plans, risks, and benefits, patients may be required to confirm their consent in writing.
• A patient will be asked to sign a treatment agreement that will detail our practice’s expectations when prescribing drugs of dependence. This agreement details the patients’ responsibilities when taking a drug of dependence, any prescriptions issues, advice on taking medications, how we will monitor their care and the standards of behaviour that are expected. This will be stored in the patient medical record.
• The authorisation of the opioid is depending on the safety risk of what the patient is on.
• Opioid medication (e.g. codeine, tramadol, morphine, buprenorphine, fentanyl) will not be initiated for chronic primary pain, unless there are other underlying conditions that warrant the use of these medications.
• Patients may need to acknowledge that their care requirements are complex, and that referral for ongoing care for all or part of continued healthcare treatment may be required. It is our practice policy that patient care is matched with the level of complexity.
• Patients are reminded that we have a Zero Tolerance policy on issues relating to staff verbal or physical abuse. Any threats to staff will result in transfer of your care.

Reviewing your medication

• All patients newly initiated on an opioid medication will be reviewed within 2-4 weeks of initiation, pain assessed, and a decision made as to the effectiveness of the drug.
• Patients on long-term opioids will be regularly reviewed to discuss slowly weaning off their opioid medication. Treatment will only be continued where there is clear on-going evidence of benefit.
• Where opioids are ineffective, they will be stopped, even if no alternative is available.