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In response to this excellent editorial and figures reported on the BBC last week that as many as 1 in 11 adults are prescribed an addictive medication (BBC news 24/1/18) it seems we are in the midst of a sea change in our thinking about chronic pain. For years we have been steadily climbing the defunct WHO analgesic ladder inexorably gaining more and more medications and their inevitable side effects; constipation, sedation, depression, anxiety, dependency and so on. GPs have unwittingly been complicit in the creation of an epidemic of prescription painkiller addiction. It is time for a change.
I am reminded of the wonderful children’s book by Julia Donaldson - ‘A squash and a squeeze’. In it a woman living in an idyllic rural location is frustrated by her lack of space. She calls a wise old man to help. One by one he introduces more and more animals into her house - first a hen, then a goat, a pig and finally a dairy cow. Chaos ensues, and the house feels ever smaller and the woman more and more alarmed until she throws her arms into the air ‘I’m tearing my hair out, I’m down on my knees’. Yet the wise old man has a plan, for one by one he withdraws the animals.....the chaos lifts and the woman is struck by the newly appreciated space in her house.
So I urge you to take off the fentanyl patch....stop the gabapentin....and tramadol....and dihydrocodeine....and codeine.....and see if the fog and chaos lifts. These p...
Show MoreCompeting Interests: None declared. - Page navigation anchor for What should be measured may be managed.What should be measured may be managed.Quinlan et al1 indicate concerns and offer solutions to prescription analgesia addiction. They highlight the paucity of data in the UK. We believe that unless some form of regulatory monitoring exists in relation to the prescription of opioids (and gabapentinoids) for chronic pain then we are fumbling in the dark. The consistency of named general practice care (currently under threat) has been a factor in the prevention of this problem. Whilst the complexity of chronic pain mandates the need for multidisciplinary care it is worth recognising that many pain problems have no solution. Some patients neither can, nor wish to deal with, the underlying psychosocial issues playing a part in their pain and iatrogenic drug dependence. We have no accurate predicator of those who will have problems but do know that doses of greater than 120mg/24hr of morphine (or equivalent)2,3 lead to poor outcomes. There are many routes that lead patients to prescription opioid dependence and even with good intentions a brave clinician may struggle to offer no analgesia in the face of severe distress. Education can only do so much. Despite education programmes and local guidelines we currently have 90 chronic pain patients in our area on morphine (or equivalent) doses greater than 600mg/24hrs.Guidelines are unable to give absolute guidance of efficacy and harm due to the poor evidence base. Monitoring need to be at a prescribing level...Show MoreCompeting Interests: None declared.