Concerns about the patient response after a PROMPPT consultation

Concerns about new medicines prescribing

Consider discussing with a GP if a patient

  • if you have feel there is scope to prescribe a new non-opioid analgesic and the patient wishes to try this option,
  • has changed, started or stopped other medicines that will potentially impact on an opioid reduction
  • e.g. increased alternative analgesic use (NSAIDs, over-the-counter opioids),
  • change in antidepressant dosing and type,
  • addition of sedative medications (e.g. benzodiazepines), gabapentinoids or amitriptyline.

Concerns about opioid addiction

As highlighted earlier in this manual, most patients taking opioids for persistent pain are not addicted to opioids. Physical dependence does not mean that patients are addicted. However, a small proportion of patients do develop behaviour that is consistent with opioid addiction.

If following your assessment, you feel there is evidence that raises the possibility of opioid misuse and addiction this warrants discussion with the GP, especially if the patient has indicated that they do not feel ready to consider reducing.

Concerns about prescribing safety:

Discuss you concerns with a GP if

  • You may encounter patients who are not willing / not ready to consider reducing opioids who you feel are at risk from unsafe prescribing, for example
    • high dose opioids and/or
    • co-prescription of opioids with other sedating / potentially dependence forming medicines such as benzodiazepines and gabapentinoids

Non-pharmacological pain management:

Discuss with a GP if

  • you need advice on the choice of alternative (non-pharmacological) strategy for coping with pain in this particular patient and /or,
  • you wish to consider referral for further help with pain management