Targeted medication review: Patients in the community with chronic pain

Patients with chronic pain may be in need of improved pharmaceutical care because of lack of pain relief and lack of understanding of pain management, the potential for drug interaction and adverse effects. This study assessed the need for a pharmacist to review the medication of a population of patients with chronic pain in a domiciliary setting, using specific validated outcome measures to determine any benefits of pharmacist intervention. Ninety-six patients who had rheumatoid arthritis or were taking regular nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics were interviewed after reviewing their medical records. Expectations of pain relief and severity of pain were assessed using McGill pain questionnaire (MPQ), visual analogue scales (VAS) and verbal descriptor scales. Twenty-eight patients required referral to their GP as a result of meeting preset criteria for poor outcome from current therapy; these patients had higher expectations of pain relief than the remaining patients and also higher pain scores. Pain scores using the MPQ and VAS were generally well correlated with each other and both showed changes in the 14 patients who were re-interviewed after pharmacist intervention. A further 59 patients required advice to optimise current therapy and 12 required referral concerning inappropriate therapy. Many patients' medicine use deviated from that prescribed, and a high proportion used alternative medicines in addition. The prescription of drugs for prophylaxis against ulceration was inappropriate in 17 patients and evidence of monitoring in patients on NSAIDs and disease-modifying antirheumatic drugs (DMARDs) was poor.