Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial

Abstract

ObjectivesTo compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain.DesignAn exploratory randomised controlled trial.SettingSix general practices with prescribing pharmacists in Grampian (3) and East Anglia (3).ParticipantsPatients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction.Randomisation and interventionPatients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible.Outcome measuresOutcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months.ResultsIn the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively).ConclusionsThis is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required.Trial registration: www.isrctn.org/ISRCTN06131530. Medical Research Council funding.

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“…Reports of pharmacist-led inpatient and outpatient pain services have been described in a host of settings and patient populations. [18][19][20][21][22][23][24][25][26][27][28][29] However, the preparation these clinicians receive within their professional degree program to undertake such roles continues to be of concern. Singh and Wyant 30 originally evaluated didactic and experiential curricular commitment of U.S. schools of pharmacy to pain with only two programs offering standalone coursework.…”

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