A research team from Keele University's Institute for Primary Care and Health Sciences has been awarded a major grant of £2.4 million from the National Institute for Health Research (NIHR) to investigate the overprescribing of opioid painkillers, and to improve care for patients with persistent pain - without the use of long-term opioids.
The research will help people with persistent (long-term) pain caused by a range of conditions, including osteoarthritis and back pain, and aims to improve patient safety by reducing inappropriate opioid use and improving the quality of life for people with persistent pain.
Nearly eight million adults in the UK sufferwithmoderate or severe persistent pain, and the use of opioid (morphine-like) painkillers has dramatically increased in the UK over the past 20 years, rising by a third between 1998 and 2016. People with persistent pain who take long-term opioids tend to have a worse quality of life than those who do not take opioids and are more likely to suffer bone fractures, addiction and overdose, especially at high doses.
Most patients with persistent pain are managed by their GP, and whilst guidelines say that GPs should review people taking long-term opioids regularly, often this does not happen.
This new research programme, led by Keele University's Professor Christian Mallen, Director of the Institute for Primary Care and Health Sciences and NIHR Research Professor in General Practice, and Dr Julie Ashworth, Senior Lecturer and Consultant in Pain Medicine, will investigate an alternative approach, training clinical pharmacists working in GP practices to help manage patients with persistent pain.
Professor Mallen explains: "Prescriptions for opioid medication continue to dramatically rise, despite limited evidence supporting their use for many painful conditions. By proactively addressing this problem and making better use of the highly skilled primary healthcare team, I hope we can rapidly improve outcomes for patients who too often suffer in silence."
The research programme will consist of three workstreams, with patients involved throughout the research process to advise on the development and design of the studies and the intervention.
The first workstream will use a range of methods to gain an in-depth understanding of patients, clinical pharmacists and GPs' experiences and views about reducing opioids, and the role of clinical pharmacists in helping people with persistent pain. Patients and expert clinicians will use the results, together with published evidence-based guidelines, to develop an intervention to help patients reduce or stop taking opioids (where appropriate) and support them to self-manage their pain. Repeated testing, with feedback from patients, GPs, and clinical pharmacists, will help to improve the intervention and training.
The second workstream will involve a study of 80 patients taking long-term opioids for persistent pain and will test how well clinical pharmacists deliver the intervention, whether it is acceptable and practical to deliver, and what proportion of patients agree to take part.
The third and final stream will include a trial of approximately 1,000 patients, testing whether the intervention leads to less opioid use, without making patients' pain worse, and whether this results in better use of NHS resources compared to usual GP care.
Dr Ashworth comments: "Patients with persistent pain often see no alternative to continuing opioids, even when they are no longer helpful or cause troublesome side-effects. In addition to reducing use of medicines that may be harming rather than helping patients, if successful, this research will ultimately also reduce NHS prescribing costs and free-up scarce resources to reinvest in more effective treatments."
MP Steve Brine, Minister for Public Health and Primary Care, said: "This exciting research comes at a time when we are tackling overprescribing head on to improve the care of those with long-term conditions and to reduce prescribing costs across the whole NHS. In understanding how we can better intervene at primary care level, we can prevent the complications that arise from long term opioid use which improves the quality of care for patients and reduces the burden on the NHS in the long-term. I would like to congratulate the research team at Keele University on receiving the grant and I look forward to following their progress."