Why are we doing this research?
Persistent pain affects up to half the UK adult population and 10-14% (around 8 million adults) say the pain causes moderate or severe interference with their life. Persistent pain means long-term pain caused by a range of conditions, but not pain caused by cancer. Sometimes it is called ‘chronic pain’. Most people with persistent pain are treated by their family doctor (GP) and many are prescribed pain medicines. Use of morphine-like painkillers called ‘opioids’ for persistent pain has increased dramatically in recent years. Twice as many people used ‘weak opioids’ (e.g. codeine) and five times more used ‘strong opioids’ (e.g. morphine, oxycodone and fentanyl patches) in 2012 compared to 2005.
However, for many people, opioids don’t help in the long-term and they often cause side-effects. Studies show that people who take regular opioids for long-term pain tend to have worse quality of life than people with long-term pain who do not take these medicines. Also, they are more likely to suffer bone fractures, addiction and overdose, especially with high doses.
Guidelines say GPs should review people taking long-term opioids regularly but often this does not happen, mainly because GPs are too busy, and many GPs say they feel dissatisfied with the care they are able to offer people with long-term pain.
A recent report recommends that clinical pharmacists should be more involved in looking after patients with long-term health problems. Clinical pharmacists are qualified pharmacists who have trained to become specialists in medicines and have done extra training in face-to-face patient care.
What does the research involve?
PROMPPT is a 5-year research programme and launched in March 2019.
Year 1 started with the Q-PROMPPT study that aimed to find out about patients, clinical pharmacists and GPs’ experiences and views on:
- Using regular medication, particularly opioids, for long-term pain
- How pain medicines are currently managed and how they could be reviewed in future
- The idea of clinical pharmacists in GP surgeries reviewing patients on regular opioids
- What would make a pain medicines review relevant, useful and appealing to patients, clinical pharmacists and GPs
The information gathered from interviews, focus groups, and an online discussion forum is currently being analysed. The findings will be used, together with published best practice guidelines, to help design a clinical pharmacist review consultation (called PROMPPT) for patients using long-term opioids for persistent pain. The team will then test how this works in practice with patients and clinical pharmacists in GP surgeries and will use the feedback from patients, GPs, and clinical pharmacists to improve the PROMPPT review and clinical pharmacist training.
Next, a study of 80 patients will test how well clinical pharmacists deliver PROMPPT, whether it is acceptable and practical to deliver, and what proportion of patients agree to take part. The research team will make improvements based on the results.
Finally, a full-scale trial with over a 1000 patients will test whether delivering PROMPPT in GP practices leads to less opioid use, without making pain or pain interference worse, and whether this results in better use of NHS resources compared to usual GP care.
What is a clinical pharmacist?
In future more clinical pharmacists will be work ing as part of the team of health professionals in GP practices, and will be able to prescribe in the same way as doctors do. The PROMPPT research aims to find out whether these clinical pharmacists can help improve care for patients who take regular opioids for long-term pain.