Prescribing wellness: comprehensive pain management outside specialist services

Prescribers or Multidisciplinarians? An Evaluation of Brief Education for General Practitioners on Chronic Pain Management

“…Participants in this study were emailed readings before the workshop (Holliday & Jammal 2015;Lack 2016;Schneiderhan, Clauw & Schwenk 2017), directed to relevant websites such as the NSW Health ACI Pain Management Network (https://www.aci.health.nsw.gov.au/chronic-pain) or the Hunter Integrated Pain Service (http://www.hnehealth.nsw.gov.au/Pain/Pages/Health professionals.aspx). Online CME and patient education resources were provided subsequently as published in detail previously (Holliday et al 2018) • Addressing coping-orientated substance use…”

“…The World Health Organization recently discontinued two CP guidelines due to the emerging science supporting non-pharmaceutical strategies, as well as reports of conflicts of interest involving the experts who developed the guidance (Dyer 2019). Evidence informed CP management emphasises non-pharmacological and noninvasive PSM (a multidisciplinary engagement with multimorbidity), the non-initiation or deprescribing of opioids, and a harm minimisation approach to addictive pharmacotherapies (Australian Commission on Safety and Quality in Health Care 2015; Department of Health 2019; Hogans et al 2018;Holliday et al 2018;Malfliet et al 2019;Manhapra & Becker 2018). The shift away from POAs reflects concerns about harms including pre-clinical research that indicates opioids may intensify and prolong pain (Grace et al 2016), and a prospective one-year clinical trial showing better outcomes from non-opioid management of musculoskeletal pain (Krebs et al 2018).…”

Standard of practice in pain management for pharmacy services

“…), Medicines Regulation Quality (Qld), Drugs and poisons information system Online Remote Access (DORA; Tas.) are available) By working with pain management units, addiction medicine (alcohol and other drugs) or mental health colleagues Where appropriate, by facilitating harm minimisation strategies, including take‐home naloxone supply and referral for staged supply for which guidance is available …”

“… policies and procedures for analgesic stewardship programs as well as resources for implementation policies and procedures for the development and revision of order sets in electronic medicines management systems for pain management policies and procedures for patient‐controlled analgesia standardisation policies and procedures for naloxone availability, including standing medication orders or nurse‐initiated naloxone and coprescribing for patients at high risk of overdose guidelines for the assessment and management of acute pain guidelines for the restricted use of high‐risk opioids (e.g. methadone, hydromorphone), high opioid doses (>90 mg morphine oral equivalent), regional analgesia and specialised analgesics (e.g.…”

“…Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine opioid dose equivalence and opioid calculator; see Appendix ) guidelines for de‐escalation of opioids and other analgesics guidelines for opioid prescribing practices for acute pain on discharge (e.g. prescribing based on pain scores and recent use and not solely on Pharmaceutical Benefits Scheme pack size) to minimise the risk of long‐term use guidelines for medication counselling for patients including simple analgesics, emphasis of indication for individual medicines, duration of treatment, discussion of adverse effects, addressing the potential that opioids may be dependence forming, resources for pain management and advice on how to de‐escalate and dispose of medicines when no longer required horizon scanning for new therapies and policies, procedures or guidelines where evidence supports use (e.g. currently there is insufficient evidence to support the use of medicinal cannabis for pain management).…”