Pain and opioids and the bigger picture

NPS MedicineWise has launched an education campaign for health professionals and consumers about opioids

The campaign looks at the role of opioids in the management of chronic, non-cancer pain and “how do we get there?”

Opioids have been under the spotlight recently due to their extent of use and risk of harms and dependency, NPS notes.

“Opioids can be an effective component of the management of acute and cancer-related pain.

“However, recent evidence shows that for most patients with chronic non-cancer pain, opioids do not provide clinically important improvement in pain or function compared with placebo.

“Additionally, they carry significant risk of harm; opioid-related harms persist or increase with time and increasing doses.”

NPS MedicineWise medical adviser Dr Jill Thistlethwaite stresses the management of chronic pain is a multifaceted and challenging topic.

“As part of our new program, NPS MedicineWise educational visitors will undertake one-on-one and small group visits in general practices around Australia,” she says.

“The goal is to equip health professionals with tools and resources to reduce the harms of opioids while ensuring adequate pain management and quality of life for patients with chronic non-cancer pain,” says Dr Thistlethwaite.

Updating health professionals on the latest evidence and guideline recommendations, the program encourages a careful consideration of all treatment options before initiating an opioid and to start the opioid with an agreed plan for stopping.

“The program includes practical tools as well as information on having conversations with the patient about opioids and chronic non-cancer pain management, supporting reducing opioid use when appropriate.

“During their general practice visits, educational visitors from NPS MedicineWise will discuss how to approach these conversations and when to involve a team of allied health professionals for multidisciplinary care,” says Dr Thistlethwaite.

The program also includes consumer resources for use in discussions with a health professional or for independent consumer use. A Pharmacy Practice Review and, later in the year, a clinical e-Audit for GPs, will provide health professionals with an opportunity to review and reflect on opioids in their work.

NPS MedicineWise consulted with several organisations, health professionals and consumers while developing the program.

Informing the program are Choosing Wisely Australia recommendations from the Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists. Choosing Wisely Australia is an initiative of NPS MedicineWise in partnership with Australia’s health professional colleges, societies and associations.

The campaign is enabling clinicians, consumers and healthcare stakeholders to start important conversations about tests, treatments and procedures where evidence shows they provide no benefit, or in some cases, lead to harm.

FPM advises avoiding prescribing opioids (particularly long-acting opioids) as first-line monotherapy for chronic non-cancer pain.

Further, it recommends not to continue opioid prescription for chronic non-cancer pain without ongoing demonstration of functional benefit, periodic attempts at dose reduction and screening for long-term harms.

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