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How pharmacists can help manage chronic pain in primary care

Pharmacists have a key role to play in helping patients manage chronic pain. Clare Bellingham finds out how they can improve their practice

Attitudes to pain

Pharmacists should be aware of patient’s attitudes and beliefs about pain in order to counsel them appropriately and define mutually agreed treatment goals, researchers say.

Interviews with patients who had undergone minor surgery revealed different strategies for coping with pain and attitudes towards analgesics (Journal of Social and Administrative Pharmacy 2001;18:219).

Chronic pain has a serious impact on a person’s day-to-day life. In many cases, treatments can be ineffective and the patient needs specialist help.

Abertay Pain Management Research Centre at the University of Abertay Dundee runs a course in chronic pain control for health care professionals working in primary care.

The centre says that demand for referral to secondary care pain clinics for chronic pain is high. This has led to a need for the development of clinics based in primary care. The aim of the centre’s chronic pain control course is to provide health care professionals with the skills to run chronic pain clinics in primary care.

The course can be studied by distance learning or at a residential course. The residential course lasts for one week and the distance learning package takes between six and 12 months to complete. The university holds residential courses in different parts of the country. This year, it plans to hold three courses in Dundee and four or five at other locations.

Some of the topics the course covers are:

  • Physiology of pain
  • Individual meanings of pain
  • Types of pain seen in chronic pain clinics
  • Pain assessment tools and the practitioner’s role in pain assessment
  • Pain clinic management strategies
  • Pharmacology of analgesics
  • Effectiveness of complementary therapies for pain relief
  • Protocols for pain control clinics

Following completion of the course, students receive a certificate in pain management.

Multidisciplinary approach

Dr David McNaughton is director of the Abertay Pain Management Research Centre and is also a pharmacist. “The course focus is on multidisciplinary working and a wide variety of practitioners have now qualified,” he says. “These practitioners include nurses, physiotherapists and pharmacists.”

He adds that 100 practitioners have now completed the course over the past two years of which 12 are pharmacists.

After completing the course, students are encouraged to set up pain management clinics in primary care. As a result, 70 clinics have been set up across the United Kingdom. Six are being run by pharmacists. However, even in the clinics run by other health professionals, Dr McNaughton sees an important role for pharmacists. “In clinics run by nurses and physiotherapists, the role of the pharmacist has been seminal in providing medication review at the first patient appointment and on an ongoing basis with regard to changes in medication. At a clinic level, it is always best to try to involve a clinical pharmacist.”

Part of the course examines the pharmacology of analgesics. It states: “Many patients who are suffering from chronic pain present in clinic having been prescribed a ‘cocktail’ of pain medications, often over a prolonged period.”

It is at this point that a pharmacist’s input is particularly useful. Dr McNaughton says: “Medication review is an inherent part of pain management. The pharmacist’s first role is to cut out any unnecessary medicine.”

The course also points out the value of pharmacist input and of taking a multidisciplinary approach in clinics. “If the pain clinic is being run by a health care professional who is not a pharmacist, it is invaluable to involve a pharmacist in a drug regimen appraisal of all their current medications. Patients who present with chronic pain often have other morbidities and an understanding of these is important. If the case is fairly complex then a team meeting may be beneficial involving a nurse, an occupation therapist, a physiotherapist, a pharmacist and a general practitioner.”

In practice

Warren Todd, a warfarin/practice support pharmacist working for Greg Moorhouse Clinical Prescribing Consultancy Ltd, a company that works for several primary care groups in the North East of England, has completed the course. “The course brings to the fore the fact that pain management needs to be tackled with a multidisciplinary approach,” he says. He adds that attending the course with other health care professionals including occupational therapists, nurses and physiotherapists brought different elements of care together and promoted to the other professions the value of the pharmacological knowledge that pharmacists could provide.

Mr Todd is now in the process of setting up a chronic pain management clinic at a GP practice in Peterlee. The clinic aims to conduct an audit of patients’ medical histories to identify patients with chronic pain. All patients taking non-steroidal anti-inflammatory drugs will be reviewed first followed by all other patients with chronic pain. He hopes that it will be up and running in about three months.

Further details about the chronic pain management course are available from

Susan Deuchars
administrator, Abertay Pain Management Research Centre
University of Abertay Dundee, Dudhope Castle
Dundee DD1 1NJ

Tel 01382 308000

Citation: The Pharmaceutical Journal URI: 20006090

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