The management of patients with chronic pain can present significant challenges, and the substantial public health harms in relation to prescription analgesics seen in the United States and elsewhere has prompted renewed efforts to assess the role of these medicines in pain management.
Complementing the BMA’s work on prescribed drugs associated with dependence and withdrawal, this briefing paper explores ways of supporting the safer prescribing of analgesics; aiming to help ensure that patients are only prescribed medicines from which they derive benefit and to limit medication associated harms.
- There were nearly 2,000 opioid-related deaths in England and Wales in 2015, an increase from 1500 from 2011 (including misuse of non-prescription opioids).
- Over recent years there have been significant increases in opioid prescribing for chronic pain, and the annual cost opioid prescribing in the UK has risen to over £330 million.
- Chronic pain is complex: An estimated 49% of patients in the UK suffering from chronic pain also suffer from depression.
- Pain management is best delivered by multidisciplinary teams, yet there is high variation in access to specialist pain management services across the UK.
Pain at end of life
'When talking about their hopes and fears about the end of life during the public events, pain was mentioned more than any other issue; the most frequent hope was that death would be quick and “pain-free”. As a corollary, being in pain was frequently mentioned as the primary fear about dying. Amongst participants who had experienced a recent bereavement, the presence or absence of pain played a key role in their memory of the death and whether or not it was deemed to have been a “good death”.
Throughout 2015 the BMA conducted a series of dialogue events across the UK, hearing from over 500 doctors and members of the public on a range of issues related to end-of-life care. The BMA’s research identified pain as a leading concern to both members of the public and doctors, when asked to consider fears about the end of life and dying.
Building on our previous work, this briefing paper explores in more detail ways of supporting improvements in pain management at the end of life, highlighting that:
- the number of people needing end-of-life care expected to rise over the next 15 years
- access to round the clock pain relief provided by specialist palliative care teams is patchy across the UK
- patients with non-cancer terminal illnesses are likely to experience poorer access to adequate pain relief than cancer patients, and are less likely to receive palliative care.