Optimising Acute Pain Management
Some patients continue to take analgesics in the long term, having started them for an acute issue, without a review of their pain or magagement plan. Establishing an approach optimising patient understanding when these medicines are initially prescribed can reduce the number of people continuing on longer-term analgesics inappropriately.
NHS Scotland’s Quality Prescribing for Chronic Pain: a Guide for Improvement promotes non-pharmaceutical approaches to management of chronic pain and potential to reduce the medication burden and associated adverse effects.
NHS Lothian has develop a Vision guideline for acute pain, which allows the clinician to use pre-populated prescriptions and highlights recent analgesic history so that patients taking analgesics for ≥12 weeks and requiring chronic pain assessment can be easily identified.
Please note: this approach should not be used for palliative patients and patients with cancer-related pain.
Good practice in prescribing for acute pain.
- Give self-management advice and outline non-pharmacological ways of managing acute pain: see Acute Pain 1-2-3 for more detail.
- Use LJF first and second choice analgesics – prescribe using the Acute Pain Vision Guideline or eLJF
- Prescribe a small quantity – smallest pack size or appropriate for around one week
- Include warnings in the directions for use:
- All analgesics: SHORT TERM USE ONLY
- Opioids – add: FOR SEVERE PAIN DUE TO RISK OF SIDE EFFECTS AND ADDICTION
- NSAIDs – add: STOP TEMPORARILY WHEN UNWELL WITH VOMITING, DIARRHOEA OR FEVER.
RESTART WHEN WELL
- Provide patient information
- Explain that the analgesic is for short term use only
- Patient Information Leaflet – print off, ask patient to view online or talk through leaflet with patient
- Opioid Painkillers – keep them short, stay safe – a simple information sheet that describes the short and long term side effects and risks of opioids
- Review recent analgesic history
- If patient has been taking analgesia for ≥12 weeks, consider a chronic pain assessment.
