With a million people in Britain currently living with long-term pain that could be better treated, new evidence suggests that extending the role of community pharmacists in pain management could lead to better outcomes for patients and help increase the cost-effectiveness of NHS care. 

Inadequate pain relief can be due to a variety of reasons. The doses of analgesic medicines used can be too low, or people may be taking excessive amounts of self-purchased and NHS-supplied painkillers. Post-surgical care may be inadequate, or it can be due to failure to diagnose cases of mixed neuropathic and other forms of pain, according to the researchers, from UCL School of Pharmacy and the University of Nottingham, reporting their findings today.

Their evaluation of the LESS PAIN community pharmacy pilot pain service, in which pharmacists at 10 community pharmacies in north London conducted enhanced pain-related Medicines Use Reviews (MURs), suggests that if the initiative were to be scaled up to a national service in England, community pharmacists could identify 50,000 or more cases of neuropathic pain in a year and around 10,000 cases of other serious illness involving pain, such as angina, they say.

Community pharmacists could also provide in excess of a million guidance sessions for pharmacy users with pain-related problems, and this ought, in certain instances such as the management of recurrent headache, to reduce counter-productive use of self-purchased and/or prescribed medicines, the authors suggest.

Pain is closely linked to depression and long-term conditions like arthritis and diabetes, they note, and also point out that while pain management services in hospitals also have an important role, by the time patients reach specialists they have offered suffered for years; better pain management in primary care would help avoid this.

"The NHS has many strengths but, from a patient perspective, care can be difficult to access conveniently and is too often poorly co-ordinated," said Professor David Colin-Thome, former national clinical director for primary care, commenting on the report's findings.

"Community pharmacists and GPs could achieve more if they worked together more effectively and focused more on user needs," noted Prof Colin-Thome.

UCL Professor David Taylor also cautioned that better day-to-day delivery of primary and community care can be neglected during discussions of NHS reform and hospital funding. "As the disappointing progress in patient-controlled record-sharing between GPs and community pharmacies can be taken to show, there is a danger of NHS commissioners and providers alike acting as unaligned businesses concerned with their own contributions and needs, rather than overall performance and value for money," said Prof Taylor, who is a former NHS Trust chair.

The authors of the pilot evaluation acknowledge that the NHS in England has many competing demands on its resources. However, despite fears that better identification of pain-related needs in the population will increase some costs - which may on occasion discourage the identification of inadequately-treated adaptive or maladaptive pain - there is mounting evidence that improving the early detection and effective management of pain-related problems in the primary and community care setting would be cost-effective, they say.