Doctors told to collaborate with community pharmacists to improve pain management

GP surgeries should work with community pharmacists to provide better pain management for their patients because it could cut GP workload, take pressure off hospital services, and reduce the financial burden on the UK economy, a report says.

The report, published by the UCL School of Pharmacy and the UK Clinical Pharmacy Association, points out that a fifth of the UK population lives with substantial pain and, at any one time, a million people have a persistent problem that could be better treated and might even have been prevented.

Relieving Persistent Pain, Improving Health Outcomes puts the cost of inadequately controlled pain to British society at more than £10bn (€12bn; $15bn) per year and says “the data available suggest that the NHS could cost effectively allocate an additional £1bn a year to better pain management services in specialist and other settings, such as community pharmacy.”

The burden of pain on society is continuing to grow the report adds, because of the ageing population and consequent increasing prevalence of pain inducing conditions, such as osteoarthritis and cancer. It also highlights “rises in the numbers of individuals with disorders such as diabetes (which can damage nerve pathways) and depression, which may lower experienced pain thresholds.”

Although the report backs the further development of specialist pain centres, it says that “improving the pain management performance of services such as a community pharmacy should play a critically important role in providing a sustainable, affordable way forward.” Some 80% of the public already list acute pain as a symptom or condition about which they would consult their pharmacist.

David Taylor, professor of pharmaceutical and public health policy at the UCL School of Pharmacy and a co-author of the report, said, “In the current economic climate it is vital to use what we already have to best effect.”

The report foresees community and other pharmacists working in collaboration with local GP surgeries to provide better pain management. “Specialised independent pharmacist prescribers, who can issue prescriptions, could for instance run weekly or monthly pain clinics and in some instances assume a direct case management role,” it says.

“This could reduce GP workloads and extend patient choice in ways that should also reduce pressures on hospital based services, especially if good working links with the other community based teams are developed.” One such clinic at Whitom in Essex is conducting a six month pilot trial involving 30 patients with persistent pain.

British Pain Society president Professor Richard Langford said, “There is a crucial role for pharmacists in advising patients. This is a real opportunity for improving care.”

In suggesting that community pharmacy is well-placed to contribute to better pain management the report draws on experience in smoking cessation, weight management and cardiovascular risk testing. The establishment of “healthy living pharmacies,” it says, is linking “health promotion work to the building of well managed pharmacy teams committed to health improvement, and the extension of pharmacy services in areas such as case finding and the direct delivery of pharmaceutical care.”