Quality prescribing for chronic pain 2026-2029: consultation

2. Executive Summary

38% of adults reported chronic pain (pain that persisted for more than three months), in the Scottish Health Survey (2022). Three-quarters of those with chronic pain experience at least one other long-term condition, including mental health disorders, heart disease and/or respiratory disease. Chronic pain can affect anyone, of any age, from any background, with or without other apparent ill health, and is impacted by health and social inequalities.

The medical model of treating pain, which required diagnosis of underlying cause and identification of the appropriate medicines to effect pain relief, is insufficient to meet the needs of practitioners and people living with long term pain. Individuals and healthcare professionals should recognise that complete relief of chronic non-cancer pain is often unrealistic. Even if effective analgesia can be achieved, more recent evidence suggests that the risk of adverse effects and harm negates this.

Taking a person-centred approach to pain management is required to understand the impact of pain on a person's life and their personal goals from treatment. The goals of assessment and management are to minimise pain, and for people to live as well as possible with the pain, balancing the potential harms of treatment with the potential benefits.

Given the limitations of efficacy and the adverse effects of medication, non-pharmacological approaches are required to support and empower individuals to self-manage chronic pain. There is no ‘one-size fits all’ approach and individuals may find different strategies beneficial, therefore time, understanding, trust, collaboration, empowerment and empathy are required to support them through their pain journey.

Medication should be reviewed at point of initiation and then monitored for its effectiveness. Those on long-term medication should be reviewed to ensure ongoing appropriateness and minimise harm/risk of harm from adverse effects, for example, people on 50mg or more morphine equivalent dose/day. Medication can generally be reduced with no adverse effects, especially when an individual is still experiencing pain despite medication, and often with an improvement in wellbeing due to reduced adverse effects. A person-centred approach, taking time and good communication, facilitates a gradual reduction, empowers the individual and encourages the use of non-pharmacological measures.

The variety of resources available support pain management by

• enabling chronic pain understanding and assessment
• improving communication
• using non-pharmacological approaches
• assessing benefits and harms of medication
• supporting tapering regimens of medication

It is possible to support and enable people with chronic pain to manage their pain and improve their lives by using the evidence available and facilitating self-management.

Kieran Dinwoodie

Chair

GP, NHS Lanarkshire GP Advisor for Chronic Pain, Modernising Patient Pathway Programme, Centre for Sustainable Delivery, NHS Scotland

Andrew Marchant

Chair

Consultant Anaesthetist, NHS Lothian

Clinical Data Advisor, Effective Prescribing and Therapeutics