Quality prescribing for chronic pain 2026-2029: consultation

18. Appendix E: Example letters to patients

The following are three example letters that can be sent to patients when reviewing chronic pain medication. These have been reproduces with kind permission from Calderside Medical Practice, Glasgow.

Example 1

Dear

There is increasing concern regarding the use of Opioid painkillers including Co-codamol, Tramadol, Codeine, Dihydrocodeine and Morphine on a long term basis.

Current evidence suggests that they are unlikely to be effective in managing chronic pain and have significant side effects and risks. Current advice is that these medications be reviewed, slowly reduced and stopped where possible.

With this in mind our Practice has adopted a new policy of not issuing these medications on a repeat basis.

We will be contacting you over the next few months to ask you to make a routine appointment with one of the Doctors or Nurse Prescribers to discuss your medication and management of your pain.

It is very important that you DO NOT STOP this medication abruptly and please be assured that we will continue to issue this medication on a short term basis when you request it until you are seen and reviewed.

Yours sincerely

The Partners of X Medical Practice

Example 2

Dear

As you may remember we sent you a letter last year advising you of our intention to undertake a review of patients currently prescribed opioid medicines on repeat to help manage chronic pain.

The aim of this review is to support our patients to achieve a reduction in the use of this group of medicines.

You may or may not be aware of the safety of these medicines and the effect they can have on health outcomes with long term use. Long term effects include:

• hypersensitivity to pain Respiratory depression
• suppression of the immune system Increased falls and fracture risk
• reduced libido/erectile dysfunction Depression and fatigue

It is important to our practice to ensure that we continue to provide a clinical service that is safe and effective with you, our patient, at the centre of it.

With this in mind we would like to offer our support to you to reduce the medication you are currently prescribed.

From your repeat record you are currently prescribed: Co-Codamol 30/500mg tablets/capsules. We would like to advise you that the process the practice has agreed to follow to manage this is:

Your current medication (as above) has been removed from repeat. This means you can no longer request this as a repeat prescription. However this does not mean we want you to abruptly stop taking this medication. It is important that we reduce this medication over a period of months.

Can you please contact the practice to make an appointment with our practice pharmacist? We will then discuss and agree a plan with you to reduce the medication. You will have the opportunity to ask any questions you may have or discuss any concerns.

We look forward to supporting and working with you to achieve this goal.

Yours sincerely

The Partners of X Medical Practice

Example 3

Dear

Our records indicate that you are receiving repeat prescriptions for Pregabalin.

In line with NHS Scotland policies we are now offering each patient who is on repeats for this drug an opportunity to review their medication with their GP or Practice Pharmacist.

Pregabalin can be effective in patients with chronic pain but studies indicate that as few as one in five patients who are being prescribed Pregabalin are actually getting any benefit from this drug. This means that 4 our of every 5 patients who are taking the drug are probably not getting any benefit and may be experiencing side effects or long term harms as a result.

Common side effects with Pregabalin include; common side effects include weight gain, memory loss, concentration problems, unsteadiness, sleep problems and sexual dysfunction. Pregabalin is known to be potentially addictive. Pregabalin only helps patients who are suffering from nerve pain rather than other types of pain.

We recommend that all our patients on long term Pregabalin undergo a trial of reducing and stopping this drug over a period of 2-4 weeks. This should always be done gradually over this time period. If you would like to discuss this further book a telephone appointment with your usual doctor. If you have already been contacted by the Practice about this recently then please accept our apologies contacting you again. We do feel, however, this it is very important that you are aware of all the facts.

Yours Sincerely,

The Partners of X Medical Practice