In order to switch things up a little bit, we thought to move away from the topic of Cancer temporarily and release a Blog entry concerning Opioid Deprescribing of relevance to pain management within the community setting.

Pain may be described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Acute pain usually arises from stimulation associated with tissue damage or injury. This form of pain is typically managed by analgesic medication and is self-limiting in nature. However, chronic pain can be considered as pain lasting beyond the normal time required for tissue healing. Management of this type of pain is more complex, frequently requiring input from the multidisciplinary team, specialist pain centres and hospices.

The World Health Organisation analgesic ladder is often applied in the clinical setting to determine the most suitable approach to pain management, with patient-centred care directly in mind. Three stages are apparent within this model, with non-opioids (e.g. paracetamol and ibuprofen), weak opioids (e.g. codeine and dihydrocodeine) and strong opioids (e.g. morphine and fentanyl) featuring. Within recent years there have been emerging concerns within the United Kingdom, and beyond, regarding the (repeated) use of strong opioids to manage both acute and chronic pain. Whilst this class of medication can be highly effective in pain management, with time persistent use can cause harm to the patient (e.g. addiction and abuse) especially at higher doses. In addition, there now appears to be little evidence of direct clinical benefit on the constant use of strong opioid medication. Hence, there has been great discussion within the healthcare community as to the potential for greater monitoring of opioid prescribing (i.e. trends associated with new prescriptions) along with a move to deprescribe chronic and / or unnecessary opioids from patient records.

In response to the pressing need to review opioid use within the community setting and potentially deprescribe this class of medicine an opioid deprescribing protocol can be applied; based upon understanding of current literature and real-world patient related factors. Here, consideration could be given to the criteria for opioid deprescribing, a deprescribing cascade (i.e. Introduction, Patient Education Stage and Review Stage) along with a section of useful support links (e.g. NHS Live Well and Supporting Minds) for patients following general discussion. For more information on this, please contact Dr Michael Davies via mike@pharmascholar.co.uk