‘What this draft guideline highlights is the fundamental importance of good communication to the experience of care for people with chronic pain’


least annually. The recommendation was made to help protect patients from addiction and overdose, plus other side effects such as increased risk of falls.


The guideline was produced at the time to respond to a significant increase in opioid prescribing for patients with chronic pain over the last few decades, despite limited evidence for their long-term effectiveness.


There had also been international concern around the rise in opioid


OPINION


Fraser Urwin, Lindsay & Gilmour, Alderston’s Pharmacy, Dunfermline Independent prescriber Fraser has a particular interest in pain and musculo-skeletal pain.


‘I think the NICE guidance is understandable,’ Fraser told SP. ‘I think that what they’re trying to say is ‘let’s not give painkillers because it may not be pain’, ie, the ‘pain’ could be psychological and therefore painkillers won’t work because it’s not actually pain.


‘I am, however, a bit dubious about the use of acupuncture as I’m not convinced that there is enough evidence to support the idea that acupuncture actually helps pain. It’s all down to people’s perceptions. They think ‘I’m in pain, I need painkillers’. Unfortunately, that’s the current mindset and so, if things are to change, it’s a matter of creating a cultural shift in people’s thinking.


‘NICE’s guidance does, I think, make sense, but it needs more in-depth research. We need more evidence about acupuncture’s role in pain killing, for example. What are we trying to sell? Are we trying to fix the pain? Or are we trying to reduce the number of patients on painkillers in general? We need to manage patients’ expectations with regard to better management of pain.


‘The type of pain is, of course, very important. The patient needs to understand what they are being treated with and why. When I carry out MURS, I tend to find that the main concern is that you are going to take their painkillers away… that you’re almost ‘deprescribing’. As I said, it’s a matter of better information for patients and of managing their expectations.’


Charles Shanks, Calder Pharmacy, Edinburgh ‘The new NICE guidelines on chronic primary pain are suggesting that treatment with commonly-used painkillers like paracetamol, co-codamol and ibuprofen are ineffective and could possibly cause other problems. As the guidance says, ‘This is because, while there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress, there was evidence that they can cause harm, including possible addiction’.


‘I like their idea of putting the patient at the centre of their own treatment and working with them in group sessions to explore the whys and wheres of their pain. I think working together in primary care with the patients would have great benefits on their management of pain. New research around the effects of diet on metabolic conditions is starting to show that a low carb, high (healthy) fat way of eating can help alleviate many of the symptoms and may lead to a reduction in pain. The mechanism appears to be a reduction of inflammation in the body. It would be good to explore this further with affected patients as it could lead to better relations between patient and the primary care team, and may lead to a better quality of life.’


prescribing and mortality rates associated with opioids: rises which had also been reflected in Scotland. In the year to 2018/19, there were 2,679,182 prescriptions for opioids dispensed in the country at a cost of around £29m.


The updated guideline was intended to provide guidance to healthcare professionals, patients and carers, on the management and treatment of chronic pain.


‘Opioids are powerful medicines,’ said Professor Lesley A Colvin, co-Chair of


the Guideline Development Group and Professor of Pain Medicine at the University of Dundee. ‘The purpose behind this review is to ensure that those who benefit from opioids for chronic pain continue to get the relief they need, but are also protected from potential harmful effects. The new evidence around potential harms and benefits has resulted in a change in our recommendations about how best to use opioids for chronic pain.


‘Opioids should only be started after careful assessment and discussion, with agreement that benefits must outweigh risks for continuing use. The best evidence tells us that better management of opioid prescribing, alongside consideration of other management strategies – such as supporting increased physical activity – with increased reviewing of patients, will give patients the protection they need.’


STOMA CARE COULD BE TRANSFORMED FOR THOUSANDS: REPORT


NHS National Services Scotland (NSS) has released the National Stoma Quality Improvement Group (NSQIG) Report: a report whose recommendations could transform stoma care for thousands of patients across Scotland.


Around 20,000 people in Scotland have a stoma, which is an opening on the abdomen connected to the digestive or urinary system to allow waste to be diverted out of the body.


Providing stoma care now costs NHS Scotland £31million a year. That figure is the result of costs increasing by 65 per cent over the previous five years. Prescribing variations, lack of clarity over best practice and inappropriate use of products mean that it can cost more than £6000 per year to provide stoma care for some patients. The average cost should be between £700 and £2300.


Specialist stoma nurses and senior nursing colleagues were part of the NSQIG, which also includes leading community and public health pharmacists, Health Board Prescribing Team representatives, General Practitioners and procurement specialists.


Craig Stewart, Associate Nursing Director, NHS Ayrshire and Arran, chaired the NSQIG.


‘The hard work and valuable contributions from all stakeholders have resulted in the report that we have released,’ he said at the launch of the report. ‘Its recommendations pave the way for an integrated national approach to stoma care that harnesses data and digital tools to deliver best-value care and an improved quality of life for patients.


‘We can transform how we deliver stoma care today and lay strong foundations for further future improvements.’


The report has now been endorsed by Scotland's Chief Nursing Officer, Fiona McQueen, and Chief Pharmaceutical Officer, Rose Marie Parr.


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