Greater Glasgow and Clyde Medicines

Chronic Pain: Primary Care Prescribing Initiatives Update

Background

In April 2018, GP practices in NHSGGC were asked to review patients prescribed lidocaine plasters and long-term strong opioids. The work was continued during 2019-2020, with the addition of review of patients prescribed gabapentinoids. The work was supported by prescribing teams including delivery of pharmacist facilitated GP educational peer sessions. The aim of these education sessions was to promote quality improvement in the prescribing of analgesic medicines in conjunction with non-pharmacological therapeutic approaches using an educational input to manage chronic pain.

Further information on the success and impact of the individual initiatives can be found in the following associated blogs:

  1. Strong Opioids for Chronic Pain: Primary Care Update
  2. Gabapentinoid Prescribing: Primary Care Update
  3. Lidocaine 5% Medicated Plasters: Primary Care Update

There is increasing evidence that many analgesics, including opioids, gabapentin and pregabalin, have potential for harm and abuse. Cases of dependency have been described and there are reports of an increasing street value and risk of drug misuse. Evidence also highlights that over recent years, there has been a significant increase in the number of drug related deaths where both gabapentin and pregabalin have been involved.

 

Key messages

  • Prescribers should continue to be mindful of analgesic initiation and consider non-pharmacological options first line for chronic pain. Refer to NHS GGC Pain Management Guidelines 
  • Review patients regularly with trials of cessation/reduction to assess for ongoing need for prescription of these medicines at the current dose
  • Prescribing of strong opioids across Scotland and within NHSGGC has reduced over the last few years and NHSGGC is currently the third lowest mainland board prescribing strong opioids in Scotland
  • Prescribing of gabapentinoids increased slightly in NHSGGC between April 2019 and March 2020, although NHSGGC continue to remain under the Scottish average
  • Despite NHSGGC prescribing initiatives over the last number of years, lidocaine plaster prescribing costs in NHSGGC have continued to rise in comparison with other boards

 

How is my practice performing?

  • You can track your practice’s progress against the National Therapeutic Indicators on the easy to read ISD dashboard available here
  • You can speak to your prescribing team for more information

 

Published 04/08/2021. Links updated 09/03/2022 and again 01/05/24.

Medicines Update blogs are correct at the time of publication.