Pharmacists and chronic pain prescribing: first RCT

In what they say is the first UK randomised controlled trial of pharmacist prescribing, UK researchers have concluded that there may be benefits for people with chronic pain from pharmacist prescribing, and that larger trials are now needed. The authors comment that despite the increasing number of pharmacists and other non-medical prescribers, rigorous outcome comparisons are lacking.

The trial assigned 196 patients from six practices with prescribing pharmacists in England and Scotland, all of whom used repeat prescriptions for pain medication (excluding certain groups such as those serious mental illness), to three groups at random – two groups received pharmacist medication review, with and without pharmacist prescribing (the former with a face to face consultation; the lattter with feedback to the GP), and one group received treatment as usual. One of the reasons for this exploratory trial was to select the best outcome measures for a larger multi-centre trial – four were used here, including both pain and generic health outcome measures.

The authors highlight the paucity of the evidence base for pharmacist prescribing using validated outcome measures, rather than the reported experiences of healthcare professionals and patients. The results suggest that pharmacist prescribing, and perhaps pharmacist medication review alone, is “feasible, acceptable and may lead to improvements in pain and other measures”, conclude the authors.

Bruhn H et al. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open 2013;3:e002361