The Faculty of Pain Medicine notes the publication of the NHS England Document: Optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms: Framework for action for ICBs and primary care, published on 2 March 2023 (publication reference: PR1103).
The FPM is supportive of the overall scope of the document, which is to help Integrated Care Boards (ICBs) achieve their key four objectives, namely:
- improving outcomes in population health and healthcare
- tackling health inequalities in outcomes, experience, and access
- enhancing productivity and value for money
- helping the NHS support broader social and economic development.
It notes in particular and is very supportive of the personalised care approach for each patient, using a multimodal approach to management and shared decision making, which does not always require including the use of medication. Non-medication modalities of management are actively encouraged.
The FPM would highlight the statement in the document “Effective, personalised care should include shared decision-making with patients and regular reviews of whether treatment is working. Patients who want to stop using a medicine must be able to access appropriate medical advice and treatment and must never be stigmatised”. The FPM would caution that it is important to recognise that the reverse is also true; that the “effective personalised care with shared decision making with patients and regular reviews of treatment” will also reveal a group of patients where medications associated with dependence or withdrawal symptoms, *and* will be providing a significant degree of pain relief and improvement in overall function and quality of life. This group of patients must also never be stigmatised and/or taken off their medication inappropriately.
The FPM advocates personalised care and shared decision making with each patient suffering from chronic pain, using multi-modal evidence-based pain management appropriately and may often include using such medication. It is vital that such medication usage is regularly reviewed and only continued if there is evidence of improvement in pain, quality of life and level of function, always balanced against a clear understanding of potential risks or side effects associated with such medication.
The document rightly advocates other treatment modalities including exercise, self-management, and psychological therapies to replace inappropriate medication. It also highlights the need for services to help patients who may have developed drug dependence to be supported appropriately. Significant investment, workforce increase and upskilling of NHS Health Professionals will be essential to meet this demand.