In a recent article we discussed the Government’s plans to make Pregabalin and Gabapentin controlled drugs and the effect this is likely to have upon the medical profession’s attitude towards gabapentinoids, as well as their ability to prescribe them.
Well, the expected stirring of the hornets’ nest has been helped on its way by an article in this month’s ‘Pulse’, the magazine for General Practitioners. In the article, entitled “GPs need a different approach to chronic pain”, the editor of Pulse, Nigel Praities, considers the long term use of strong painkillers.
In relation to the proposals for Pregabalin and Gabapentin, he says “this change alone will not tackle a situation in which many patients are overmedicated with potent painkillers that often don’t work and are ripe for misuse.”
Arguing that “the whole system colludes to pump chronic pain patients full of drugs, without addressing the root causes of their condition”, he goes on to state that “I am not saying GPs should refuse to treat any pain with pills – that would be callous and very cruel. But potent analgesics should be a stop-gap, not a sink hole. A new approach is needed for the management of chronic pain – one that does not continually default to the readily available pharmacological option.”
What does he believe is the answer?
He says that “most GPs I speak to” don’t believe that drugs are the answer, “but what are they expected to do when waits for psychology, physiotherapy or occupational therapy can stretch to several months? Leave the patient with no support at all? Pain is a multifaceted and complex condition and should be treated as such, with GPs being supported to explore a multidisciplinary response and encourage better self-care, rather than having no choice but to reach for the green pad.”
Understandably, the reaction to this article has been considerable, both on the Pulse website and on social media more generally. One commentator, a retired GP, said “I disagree with your conclusions on this occasion. As an experienced GP and as a sufferer of neuropathic pain myself (quite appropriately and very successfully treated with pregabalin via initial pain clinic assessments and recommendation), I and most GPs know these drugs are a godsend for people whose lives would otherwise be severely blighted. I am sure however that all GPs will be anxious to ensure these are not used inappropriately.”
This commentator believes that the real problem is painkillers falling into the wrong hands. He continues, “The answer is not to make the correct use of these medications fall under suspicion and risk failure to prescribe where clinically appropriate what is an extremely effective treatment for neuropathic pain.”
However, in a reply likely to concern many people suffering chronic pain, another GP comments, “A good balanced article. Give me forty minutes with every chronic pain patient and I’m sure I could get a lot of them to reduce or stop a lot of their medication. Problem is in the real world we have 10 minutes and these are usually patients with multiple complex problems and most would not even see polypharmacy as one of their problems.”
Clearly, with such divergent views, the road ahead is set to be a rocky one.