Revised chronic pain guideline backs early review for patients prescribed opioids

Patients prescribed opioids should be reviewed soon after starting new medication and receive ongoing reviews at least annually, according to updated guidelines on chronic pain management.

Chronic pain advice from the Scottish Intercollegiate Guidelines Network (SIGN) - part of Health Improvement Scotland - has been overhauled amid rising rates of opioid prescribing.

In the year to 2018/19, 2.7m prescriptions for opioids were dispensed in Scotland at a cost of around £29m. In England, prescriptions for opioid analgesics rose from 14.8m in 2008 to 23.4m in 2018, NHS Digital figures show - with the annual cost now almost £240m.

The SIGN recommendation that patients prescribed opioids - including codeine, morphine and tramadol - for pain management should be reviewed more frequently aims to reduce the risk of addiction, overdose and other side effects including increased falls risk.

The updated SIGN guideline classifies chronic pain as 'persistent, long-term pain lasting more than 12 weeks'. One in five people in Scotland are affected, including people with long-term conditions such as diabetes, arthritis and back pain.

Chronic pain

The updated guideline follows a review of the latest evidence on potential harms from opioids. Professor Lesley A Colvin, co-chair of the guideline development group and professor of pain medicine at the University of Dundee, said: 'Opioids are powerful medicines. 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.'

Dr Safia Qureshi, director of evidence for Healthcare Improvement Scotland, said: 'It’s important that those who need strong pain relief get the medication they need, but are kept safe from the dangerous side-effects associated with these powerful medicines. We would urge healthcare professionals to make use of the updated guideline to ensure that people get the best possible care.'

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