Short Life Working Group On Prescription Medicine Dependence And Withdrawal: consultation

Chronic Pain

Chronic pain is defined as pain which has persisted beyond normal tissue healing time.^[1] It is estimated that 1 in 5 people in Europe suffer from chronic pain, with 1 in 20 people in Scotland suffering severe, disabling chronic pain.^[2] Chronic pain is a condition which is individual to the patient and any therapeutic management plan needs to place the patient at the centre. The approach should be based on assisting the patient to achieve goals which have been identified in partnership with the prescriber, adopting the what matters to me principle.

Prescribing for chronic pain in Scotland increased by 66% over the ten years from 2006.^[3] Commonly prescribed drugs include classes of medicines covered by the work of the SLWG, including opioids and gabapentinoids. Many people with chronic pain may also be prescribed medicines associated with dependence including benzodiazepine, z-drugs and sedating agents. Therefore the recommendations of the SLWG will be used to complement and inform improved prescribing and support for people with chronic pain.

There is growing concern about the rise of prescribed opioid use for chronic pain, both in the UK and internationally, not least because of the risk of dependence and given the very limited evidence for their effectiveness in long term pain conditions. In order to support prescribers and people with chronic pain alike in identifying the most appropriate management plan, the Scottish Government has supported the development of clinical and prescribing guidance. This includes SIGN 136 – Management of Chronic Pain and its companion document, Quality Prescribing for Chronic Pain – A Guide for Improvement 2018-2021.

Improving services and support for people with chronic pain in Scotland remains a priority for the Scottish Government. The Programme for Government 20/21 contains a number of commitments on chronic pain service improvement based on feedback from clinicians, as well as patient groups and third sector, regarding the importance of pathways to provide a sustainable model that will deliver better outcomes and reduce unwarranted variation and health inequalities across Scotland.

As part of this work, in September 2020 the Government published a Framework for Recovery of NHS Pain Management Services to support the rapid and safe remobilisation of specialist pain management services in Scotland which were paused during the initial wave of the COVID-19 pandemic. The National Advisory Committee for Chronic Pain (NACCP) has also undergone a review including increased representation of people with lived experience, and in 2021 the Scottish Government will publish a new Framework for chronic pain Service Delivery which will update the current Scottish Service Model for chronic pain.