Prescribed opioid medication and chronic pain

CFMHAS has a major programme of clinical innovation and research into the use of high dose opioid drugs in the treatment of chronic pain. We are unusual in regarding the problem as unrelated to addiction, but more closely aligned to iatrogenesis. Rob Poole and Lucy Jones, Clinical Nurse Specialist in Pain Management, developed a service that offered demonstrably effective responses for patients who experience severe side effects and little pain relief on treatment with high dose opioids. More recently, a pharmacist, Simon Gill, has developed a similar intervention in primary care, and has influenced Welsh national policy.

Although there has been some significant institutional and professional resistance to this work, it continues and we are evaluating the intervention. We have a group of clinical staff and researchers working on a series of related projects, examining community prevalence, patterns of high dose prescribed opioid use, cognitive effects of high dose opioids, patient and carer experience of high dose opioid use, use of opioids in cancer care and evaluation of a programme of psychoactive medicines management in a prison setting. We are developing work with prescribers, including an intervention to help GPs to avoid prescribing high dose opioids.

Much of this work is led by John Bailey.

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