Polypharmacy prescribing guidance - draft: consultation

6. Long-term conditions: Chronic pain, Diabetes

Chronic pain

Chronic pain, also called persistent pain, is defined as persistent or recurring pain that lasts longer than three months despite medication or treatment and is a recognised long-term condition.

• People living with pain need to be supported and empowered to manage their pain, considering non-pharmaceutical options in the first instance
• Individuals should have access to personalised information and support with an awareness that chronic pain is a long-term condition. The goal is increased function and improved quality of life
• Healthcare professionals and individuals should have honest conversations about the role of medication in the management of chronic pain, regarding efficacy, dependency and possibly withdrawal
• Opioids should only be considered for short to medium-term treatment (less than three months) for carefully selected individuals with chronic non-malignant pain, when other therapies have been insufficient and the benefits are greater than the risks of serious harms
• Antidepressants and gabapentinoids can be considered depending on the indication, but the risk of adverse effects must be considered against the benefits (e.g. numbers needed to harm versus numbers needed to treat)
• Regularly review medication, and discuss withdrawing medication if appropriate:
• Those suffering chronic pain with co-existing depressions should have their antidepressant therapy optimised, rather than adding a subsequent antidepressant medication
• Individuals who cannot stop their medication should be encouraged to reduce to the lowest effective dose

Diabetes

Management of type 2 diabetes mellitus (T2DM) can reduce symptoms of hyperglycaemia and reduce long-term complications. The aim of this hot topic is to ensure that these are prescribed safely.

• Lifestyle management is the fundamental aspect of diabetes care.
• Consider co-morbidities, such as atherosclerotic cardiovascular disease, chronic heart failure and chronic kidney disease, and prescribe SGLT-2 inhibitors and GLP-1 receptor agonist, where appropriate, to improve long-term outcomes.
• In frailty, diabetic control should be individualised to reduce the risk of hypoglycaemia

Question 6a

Do you agree or disagree with the recommendations for management of chronic pain?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 6b

Please provide any further comments about our recommendations.

Question 6c

Do you agree or disagree with the recommendations for management of type 2 diabetes?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 6d

Please provide any further comments about our recommendations.