Quality prescribing for chronic pain 2026-2029: consultation

Consultation questions

1. Medication review

We recommend taking a holistic approach to manage pain, with medications being reviewed using a person-centred approach using the standardised Polypharmacy 7-Steps guidance.

Question 1a

Do you agree with this recommendation? (Yes/No/Not sure)

Question 1b

To what extent do you agree with this recommendation?

Question 1c

Please tell us more about your views on our approach to review.

2. Communication between practitioners and people experiencing chronic pain

We recommend that practitioners acknowledge that chronic pain is a long-term condition and people will be at different stages of their chronic pain journey. Practitioners should take a person-centred approach when communicating with individuals.

Question 2a

Do you agree with our recommendations around communication between practitioners and people experiencing chronic pain?

Question 2b

To what extent do you agree with these recommendations?

Question 2c

Please tell us more about your views on our recommendations.

3. Non-pharmacological approaches

We recommend that clinicians should:

• support individuals to explore non-pharmacological treatment options to manage their chronic pain, including self-management, physical activity, relaxation and psychological therapies
• support person-centred goal setting in management of chronic pain which are specific, measurable, achievable, realistic and timed (SMART)
• consider using local social prescribing and community resources.

Question 3a

Do you agree with our recommendations around using non-pharmacological approaches to managing chronic pain?

Question 3b

To what extent do you agree with these recommendations?

Question 3c

Please tell us more about your views on our recommendations.

4. Pharmacological management

We recommend that clinicians should:

• Review the indication and impact of medicines considering not only pain intensity levels, but also the effect on physical function, mental health and emotional factors. The risks of harm/adverse effects should be considered both actual and potential.
• Consider a two-to-four-week trial of regular paracetamol to assess efficacy
• Review treatment of all people on an opioid, prioritising individuals prescribed more than 50mg morphine equivalent dose (MED), who should be reviewed at least annually.
• Review efficacy and adverse effects within four weeks of starting opioid treatment or sooner if required.
• Review effectiveness of duloxetine after four weeks at 60-120mg and discontinue if there is no improvement in pain relief, physical function or subjective improvement. It is good practice to reduce gradually.
• Optimise antidepressant medication where possible in those with concomitant chronic pain and depression, rather than prescribe additional antidepressant medication
• Inform of significant risk of adverse effects with gabapentinoids, including drowsiness, dizziness, nausea, weight changes (abnormal appetite), cognition, speech problems and ataxia
• Review use of nefopam, lidocaine plasters, methocarbamol as there is limited clinical evidence.

Question 4a

Do you agree with our recommendation for the use and review of medicines used to treat chronic pain?

Question 4b

To what extent do you agree with these recommendations?

Question 4c

Please tell us more about your views on our recommendations.

5. Opioid stewardship and deprescribing

We recommend that clinicians:

• In partnership with the individual, consider managed reduction of opioids, as there is little evidence that they are effective for long-term pain but have many side effects and known long-term harms.
• Explain the importance of reducing opioids to the individual, providing chronic pain education, if necessary, and develop a tapering plan in agreement with the individual.
• Support the individual during the reduction, considering emotional impact and adverse effects.
• In secondary care, consider good opioid stewardship, ensuring effective communication between secondary care and primary care, noting that long-acting opioids are no longer recommended post-surgery.

Question 5a

Do you agree with our recommendations for opioid stewardship and deprescribing for chronic pain?

Question 5b

To what extent do you agree with these recommendations?

Question 5c

Please tell us more about your views on our recommendations

6. Resources for practitioners and people with chronic pain

Question 6a

Are you aware of any other resources that practitioners or people with chronic pain or may find useful? (Yes/No/)

Question 6b

If your answer to question 6a was Yes, please list any other resources that you are aware of.

7. Implementation of this guidance

We have a few questions, which will help us implement the recommendations from this prescribing guide.

Question 7a

Do you feel there are any barriers to implementing the recommendations from this guidance? (Yes/No/Not sure)

Question 7b

If you answered yes, how do you feel these barriers could be addressed? Question

Question 7c

What do you feel are the key factors that will enable successful implementation of these recommendations?

8. Finally

Question 8

Do you have any further comments on this prescribing guide?