Batten down the hatches

The Guild defends its Chronic Pain MedsCheck Trial after further criticism, this time from a leading Australian pain specialist body

The Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists has called on the federal government to reconsider its support of a $20 million trial that funds pain assessments by pharmacists.

In a release, the college says it fears the trial “promotes medication as the only option to relieve chronic pain”.

Dr Meredith Craigie, Dean of the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists, has written to Federal Health Minister Greg Hunt expressing concern that the government’s Chronic Pain MedsCheck scheme has been introduced with no input from specialist pain medicine physicians.

The faculty says it is also alarmed that participating pharmacists are assessing people with chronic pain after undergoing just three-to-four hours of online training.

“Pain medicine is a two-year post-specialty qualification for doctors, including GPs, psychiatrists, rehabilitation specialists, physicians, anaesthetists and surgeons,” says the faculty.

“While we welcome the substantial new investment in chronic pain care, the faculty is concerned that the scheme has been developed without appropriate input from medical specialists and does not adequately recognise that the successful treatment of chronic pain requires a complex, co-ordinated approach,” says Dr Craigie.

“Chronic pain treatment includes movement, physiotherapy and psychosocial interventions and needs to be much broader than focusing on medications which in many cases are ineffective.

“Unfortunately there’s a perception that chronic pain can only be treated by drugs such as opioids. This has in part led to the opioid crisis we are seeing today where patients take increasing doses of opioids to relieve pain and end up with serious complications including dependence, addiction or even death, especially when mixed with other sedatives like benzodiazepines.”

Under the trial pharmacists are funded for an initial 45-minute consultation to assess the patient’s medicines and their pain management strategies. A 15-minute follow-up will be given three months later to see if the pharmacist’s intervention has made a difference.

“No rationale has been advanced based on research or current best practice guidelines that would lead anyone to expect that such a brief and narrowly targeted intervention might be of use for chronic pain,” says Dr Craigie.

“It is appropriate for pharmacists to concentrate on the pharmaceutical aspects of a pain care plan but not in the absence of consultation with prescribers and the rest of the patient’s treatment team.”

The Pharmacy Guild of Australia has expressed disappointment at criticism of the trial.

“Unfortunately the Faculty has misrepresented or misunderstood the collaborative nature of this important trial,” says Pharmacy Guild national president George Tambassis.

“Pharmacists are doing Chronic Pain MedsChecks for patients with established chronic pain just as they do other MedsChecks now for patients suffering from all sorts of existing conditions including diabetes.

“This is a trial to collect data with independent researchers and a thorough evaluation,” Mr Tambassis says.

“No one has ever said it would be a panacea, but no one can deny after the recent codeine debate that it is important for pharmacists to use their medicines expertise to help deliver quality outcomes for patients, including encouraging them to talk to their GP and other health professionals if potential issues are found.

“My advice to the Faculty of pain specialists would be to get behind this trial in the interests of patients with longstanding, complex chronic pain,” he says.

An invitation is reportedly being extended by the Trial Expert Panel to the Faculty of Medicine (ANZCA) to participate as a member of the panel, and their feedback is welcome.

This week will see the release of online training to support community pharmacies participating in trial interventions with eligible chronic pain patients.

The Chronic Pain MedsCheck Trial training modules will provide supplementary education resources for pharmacists on the complex condition of chronic pain, including both medicines and non-pharmacological management strategies.

According to the Guild, the role of community pharmacies in the trial includes:

  • supported self-management of patients taking medication who are dealing with chronic pain for more than three months through pharmacist advice;
  • pharmacy-based evaluation of patients’ medicine;
  • provision of an action plan which will incorporate education, self-management and referral to other health professionals where additional support is required;
  • three month follow up after the initial service.

However not-for-profit independent organisation NPS MedicineWise has previously encouraged Australians who suffer pain for longer than three months to visit their GP to have their condition checked.

Dr Andrew Boyden, medical advisor with NPS MedicineWise says, “If pain continues for more than three months it becomes a form of chronic pain.”

He says such pain could actually be neuropathic pain, which needs to be assessed by a GP.

“Working out if neuropathic pain is behind the patient’s discomfort will help them to receive the best treatment,” says Dr Boyden.

“The main message of our Neuropathic Pain program for everyday Australians is that if you have suffered with pain for over three months, it’s important to have your pain assessed by a GP,” NPS MedicineWise told AJP.

The Chronic Pain MedsCheck trial has also previously been criticised by Chronic Pain Australia as well as the AMA and GPs.

Meanwhile pain expert and pharmacist Joyce McSwan, Managing Director of PainWise, says the program will add value.

“Pain MedsChecks [are] really exciting because for so long we’ve had MedsChecks, we’ve been able to do some really good chronic disease management,” she told AJP.

“Aside from the acute interaction over the counter, Pain MedsChecks allow us to have that conversation for chronic care extension.

“At the moment we’re writing guidelines, we’re putting together a trial, hopefully to get that as right as we can and to practise within the scope of pharmacy practice, what we can contribute in the safety and efficacy of this space,” said Ms McSwan in June this year.

“It still comes back to our core fundamental role in quality use of medicines. It will come back to that, and it will look different for different patients – with some guidelines of course.

“It will always start with assessment, so I think part of the guidelines will be very much the assessment of ‘what have we got before us?’ and then tacking on appropriate treatment. Probably a little bit of rationalising of their current treatment: ‘is it safe? Is it the best we can do?’”

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  1. Ex-Pharmacist

    I think most of us know where this “Chronic Pain MedsCheck Trial” was hatched.
    Just another back-room deal between the Guild and the health minister after, by all reports, furious lobbying around Codeine supply from retail pharmacies. When that initiative failed, this half-baked trial was hatched, presumably as some sort of compensation.

    The AMA saw right through it of course >

    • Nicholas Logan

      Would that be the AMA who represents an insignificant percentage of medicos and now only exists as an angry little pharmacy guild attack dog?

      • Paige

        The guild only represents 15% of our profession – People in glass houses Nick.

  2. Nicholas Logan

    The Chronic Pain MedsCheck expert panel voted unanimously to encourage representation from FOPM and RACGP.

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