Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial
Open accessAbstract
Objectives: To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain. Design: An exploratory randomised controlled trial. Setting: Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3). Participants: Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) completed. Exclusion criteria included: severe mental illness, terminally ill, cancer related pain, history of addiction. Randomisation and intervention: Patients were randomised using a remote telephone service to: (1) pharmacist medication review with face-to-face pharmacist prescribing; (2) pharmacist medication review with feedback to GP and no planned patient contact or (3) treatment as usual (TAU). Blinding was not possible. Outcome measures: Outcomes were the SF-12v2, the Chronic Pain Grade (CPG), the Health Utilities Index 3 and the Hospital Anxiety and Depression Scale (HADS). Outcomes were collected at 0, 3 and 6 months. Results: In the prescribing arm (n=70) two patients were excluded/nine withdrew. In the review arm (n=63) one was excluded/three withdrew. In the TAU arm (n=63) four withdrew. Compared with baseline, patients had an improved CPG in the prescribing arm, 47.7% (21/44; p=0.003) and in the review arm, 38.6% (17/44; p=0.001), but not the TAU group, 31.3% (15/48; ns). The SF-12 Physical Component Score showed no effect in the prescribing or review arms but improvement in TAU (p=0.02). The SF-12 Mental Component Score showed no effect for the prescribing or review arms and deterioration in the TAU arm (p=0.002). HADS scores improved within the prescribing arm for depression (p=0.022) and anxiety (p=0.007), between groups (p=0.022 and p=0.045, respectively). Conclusions: This is the first randomised controlled trial of pharmacist prescribing in the UK, and suggests that there may be a benefit for patients with chronic pain. A larger trial is required. Trial registration: www.isrctn.org/ISRCTN06131530 . Medical Research Council funding.
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Pharmacist prescribing in primary care has the potential to confer additional benefit over medication review alone.
“Pharmacists have expertise in therapeutics and polypharmacy, and new research demonstrates that pharmacist prescribing in primary care has the potential to confer additional benefit over medication review alone [64].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [64]
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- Authors
- Bruhn, H., Bond, C. M., Elliott, A. M., Hannaford, P. C., Lee, A. J., McNamee, P., Smith, B. H., Watson, M. C., Holland, R., & Wright, D.
- Affiliations
- University of Aberdeen (GB)
- University of Dundee (GB)
- University of East Anglia (GB)
- Corresponding author
- Bond, Christine M
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2013
- Volume
- 3
- Issue
- 4
- Pages
- e002361
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC3641445
- OpenAlex
- W1994295201
- Cited by
- 99
- References
- 36
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 7 · 2023: 8 · 2022: 6 · 2021: 8 · 2020: 8 · 2019: 15 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 12 · 2014: 7 · 2013: 2
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (acceptedVersion, other-oa)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion, cc-by-nc)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- chronic pain, pharmacist prescribing, pharmacist medication review, primary care, analgesics, quality of life, anxiety, depression, health-related quality of life, health utility, SF-12, prescribing appropriateness
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