Current status of opioid epidemic in the United Kingdom and strategies for treatment optimisation in chronic pain

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Abstract

The increase in opioid prescriptions in the United States has been accompanied by an increase in misuse as well as overdose and toxicity related morbidity and mortality. However, the extent of the increased opioid use, including misuse in the United Kingdom, currently remains less debated. Recent studies in the United Kingdom have shown a rise in opioid use and attributed deaths, particularly in areas with higher deprivation. There are also large variations amongst the devolved nations; Scotland has the highest drug-related deaths and year-on-year increase within Europe. Better clinical guidelines that can enable person-centred management of chronic pain, medicines optimisation, and early diagnosis and treatment of opioid use disorder are crucial to addressing opioid-related morbidity and mortality in the United Kingdom.

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Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.

Harald Breivik, Beverly Collett, Vittorio Ventafridda … (2006)

This large scale computer-assisted telephone survey was undertaken to explore the prevalence, severity, treatment and impact of chronic pain in 15 European countries and Israel. Screening interviews identified respondents aged 18 years with chronic pain for in-depth interviews. 19% of 46,394 respondents willing to participate (refusal rate 46%) had suffered pain for 6 months, had experienced pain in the last month and several times during the last week. Their pain intensity was 5 on a 10-point Numeric Rating Scale (NRS) (1 = no pain, 10 = worst pain imaginable) during last episode of pain. In-depth interviews with 4839 respondents with chronic pain (about 300 per country) showed: 66% had moderate pain (NRS = 5-7), 34% had severe pain (NRS = 8-10), 46% had constant pain, 54% had intermittent pain. 59% had suffered with pain for two to 15 years, 21% had been diagnosed with depression because of their pain, 61% were less able or unable to work outside the home, 19% had lost their job and 13% had changed jobs because of their pain. 60% visited their doctor about their pain 2-9 times in the last six months. Only 2% were currently treated by a pain management specialist. One-third of the chronic pain sufferers were currently not being treated. Two-thirds used non-medication treatments, e.g,. massage (30%), physical therapy (21%), acupuncture (13%). Almost half were taking non-prescription analgesics; 'over the counter' (OTC) NSAIDs (55%), paracetamol (43%), weak opioids (13%). Two-thirds were taking prescription medicines: NSAIDs (44%), weak opioids (23%), paracetamol (18%), COX-2 inhibitors (1-36%), and strong opioids (5%). Forty percent had inadequate management of their pain. Interesting differences between countries were observed, possibly reflecting differences in cultural background and local traditions in managing chronic pain. Chronic pain of moderate to severe intensity occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Very few were managed by pain specialists and nearly half received inadequate pain management. Although differences were observed between the 16 countries, we have documented that chronic pain is a major health care problem in Europe that needs to be taken more seriously.

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Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies

A Fayaz, Darren Croft, R Langford … (2016)

Objectives There is little consensus regarding the burden of pain in the UK. The purpose of this review was to synthesise existing data on the prevalence of various chronic pain phenotypes in order to produce accurate and contemporary national estimates. Design Major electronic databases were searched for articles published after 1990, reporting population-based prevalence estimates of chronic pain (pain lasting >3 months), chronic widespread pain, fibromyalgia and chronic neuropathic pain. Pooled prevalence estimates were calculated for chronic pain and chronic widespread pain. Results Of the 1737 articles generated through our searches, 19 studies matched our inclusion criteria, presenting data from 139 933 adult residents of the UK. The prevalence of chronic pain, derived from 7 studies, ranged from 35.0% to 51.3% (pooled estimate 43.5%, 95% CIs 38.4% to 48.6%). The prevalence of moderate-severely disabling chronic pain (Von Korff grades III/IV), based on 4 studies, ranged from 10.4% to 14.3%. 12 studies stratified chronic pain prevalence by age group, demonstrating a trend towards increasing prevalence with increasing age from 14.3% in 18–25 years old, to 62% in the over 75 age group, although the prevalence of chronic pain in young people (18–39 years old) may be as high as 30%. Reported prevalence estimates were summarised for chronic widespread pain (pooled estimate 14.2%, 95% CI 12.3% to 16.1%; 5 studies), chronic neuropathic pain (8.2% to 8.9%; 2 studies) and fibromyalgia (5.4%; 1 study). Chronic pain was more common in female than male participants, across all measured phenotypes. Conclusions Chronic pain affects between one-third and one-half of the population of the UK, corresponding to just under 28 million adults, based on data from the best available published studies. This figure is likely to increase further in line with an ageing population.

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Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

Erin E Krebs, Amy Gravely, Sean Nugent … (2018)

Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain.

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Contributors

Vibhu Paudyal:

ORCID: http://orcid.org/0000-0002-4173-6490

v.paudyal@bham.ac.uk

Journal

Journal ID (nlm-ta): Int J Clin Pharm

Journal ID (iso-abbrev): Int J Clin Pharm

Title: International Journal of Clinical Pharmacy

Publisher: Springer International Publishing (Cham )

ISSN (Print): 2210-7703

ISSN (Electronic): 2210-7711

Publication date (Electronic): 30 November 2020

Publication date PMC-release: 30 November 2020

Publication date (Print): 2021

Volume: 43

Issue: 2

Pages: 318-322

Affiliations

GRID grid.6572.6, ISNI 0000 0004 1936 7486, School of Pharmacy, , University of Birmingham, ; Birmingham, B15 2TT UK

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Vibhu Paudyal http://orcid.org/0000-0002-4173-6490

Article

Publisher ID: 1205

DOI: 10.1007/s11096-020-01205-y

PMC ID: 8079300

PubMed ID: 33252724

SO-VID: c48d0f3f-c28a-49a2-ad5d-b622ac81a47d

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Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 1 April 2020

Date accepted : 17 November 2020

Funding

Funded by: University of Birmingham

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ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine

Keywords: chronic non-malignant pain,chronic opioid therapy,opioid use disorder,united kingdom

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ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine

Keywords: chronic non-malignant pain, chronic opioid therapy, opioid use disorder, united kingdom

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Current status of opioid epidemic in the United Kingdom and strategies for treatment optimisation in chronic pain

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Most cited references 20

Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.

Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

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