WS3 The initial consultation Copy

It is advised that 30 minutes is scheduled for the first PROMPPT consultation (not including time to complete study documentation). This consultation may be conducted face-to-face or remotely by video or telephone, depending on the impact of COVID-19 on service provision and any ongoing social distancing measures.

The initial consultation includes assessment of the patient’s perspective regarding their pain and its management and the impact of pain on their life, followed by a personalised discussion to explore the patient’s experience and perspective on the effects (wanted/unwanted, useful/bothersome) of opioids.

Motivational interviewing techniques will be used to explore patient’s reasons for considering changing their opioid medicines, their readiness to change and any ambivalence, before agreeing an individualised management plan.  Management plans will arise from shared decision making. The plan may include opioid tapering but this will not be mandatory, for example if the patient obtains continued useful benefit from moderate dose opioids, without experiencing troublesome side-effects. 

Where changes to medicines are agreed, SMART (specific, measurable, achievable, realistic, time‐related) goal setting will be used to facilitate translation of intentions into action. Important barriers to reducing opioids, for example fear of pain worsening and/or withdrawal symptoms following opioid reduction, will be addressed on an individual basis.

Management plans may also include advice and goals relating to self-management, signposting to information resources, signposting or referral to appropriate community services (for example physiotherapy and mental health support services) and, for more complex cases, discussion/collaboration with the GP and/or referral to specialist services if needed.