Managing chronic pain is a challenge for patients and their treating doctors. The focus on reducing the use of opioids as a first line treatment in emergency department settings and for long term pain management puts additional pressure on clinicians in responding to patients seeking immediate pain relief. Opioids might provide immediate, short term relief but they have a lot of serious downsides including addiction, overdose and in some cases death.
What are the alternatives?
A recent NSW trial has demonstrated a 24% reduction in opioid prescribing for patients with acute back pain in emergency departments. 300 clinicians were trained to assess, manage and refer patients presenting with acute back pain without necessarily prescribing opioids and to provide alternatives such as other medications and heat wraps. A key to the success of this trial was patient education and clear communication as well as a process for enabling fast track referrals to outpatient services including physiotherapy, primary care and specialist back clinics when required. Overall, the feedback was positive. The ED team embraced the trial as they could see positive results immediately and the patients were pleased to receive focussed care. The results of this trial have been published in BMJ Quality and Safety.
MIGA ran a claims hypothetical – “Who dunnit? – the poisonous pill” as part of the 2017/2018 Risk Management Program. It was based on a Coronial investigation into the death of a young mother and sports person from prescription overdose. Sadly, it is estimated, each day, three people die from drug-induced deaths involving opioids, the majority related to prescription overdose¹. We followed this hypothetical with an online module on Opioids and a recent Webinar on the TGA and PBS legislative changes in relation to opioid prescribing. MIGA doctors can access the module and the webinar recording by logging into REO from the website or directly at reo.miga.com.au . Both activities attract 5 MIGA Points each².
It is apparent from doctors attending the hypothetical and the webinar that assistance is needed in understanding what safe and effective treatments (medical and non-medical) are available, how to communicate to patients a clear treatment strategy and how to manage the process of deprescribing patients away from opioids.
Resources to help you
MIGA will be hosting a follow up webinar later this year on the pragmatics of managing chronic pain and de-prescribing.
In the meantime, there are some excellent resources available to clinicians and their patients. Here are some of them:
- The ACI Pain Management Network which has resources for patients and clinicians
- Pain Australia
- Reach for the facts
- Choosing wisely Australia
- NPS: Opioids, chronic pain and the bigger picture
- The opioid calculator app – when does a patient reach the danger zone
- The Brainman series of videos explaining pain
These can be useful in enabling patients to self-educate on the topic, making them more aware of the implications of their treatment, promoting healthy discussion and potentially increasing motivation to try alternatives.
A more complete list of useful resources on opioid prescribing and the alternatives (including available modules, guidelines and legislative changes) can be found in the education section of the website at Prescription medications.
If you require further information and advice, please contact our Legal Services team on 1800 839 280.