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Nurse/Non-Medical Prescribing for Pain: Speaker Presentations

Chaired by Professor Matt Griffiths Independent Consultant Nurse, Advanced Nurse Practitioner, Visiting Professor of Prescribing & Medicines Management and Member The Association for Prescribers this important national conference provided an essential update for current and aspiring nurse/non-medical prescribers on prescribing for pain.

Pain is a growing area of nurse/non-medical prescribing and one of the most common areas, in a 2010 survey of the Association for Prescribers members 50% of members prescribed for pain (Karen Stenner, University of Surrey). This make it essential that nurse/non-medical prescribers maintain the competence and skills to prescribe for pain in an effective way, working with patients to improve pain outcomes.

Through national updates and practical case studies delegates heard how to develop and maintain prescribing competence, and how to develop effectiveness in post qualification practice.

Professor Matt Griffiths Independent Consultant Nurse, Advanced Nurse Practitioner, Visiting Professor of Prescribing & Medicines Management and Member The Association for Prescribers opened the conference with a national update on Nurse/Non-Medical Prescribing. In his presentation Professor Griffiths discussed:

  • national developments in nurse/Non-Medical prescribing
  • developing confidence and competence in your ability to prescribe
  • demonstrating compliance with the NMC Code for revalidation
  • the benefits of nurse/non-medical prescribing for pain

Professor Griffith's full Presentation  

In his presentation Professor Mark Griffith's Stated: 

‘10% of our nurses are now prescribers’

‘We measure competence but we don’t measure confidence – This is a real issue.’ ‘Its important for nurses to be given support when they begin to prescribe’

‘The NMC have a new code of revalidation – Early results are favourable’

‘1 in 4 referrals to the NMC are to do with medicines’

‘Complaints can be just as useful as compliments – keep these you can learn a lot from them’

‘Pain is a terrible infliction – It cannot be seen’

‘Nurses are very good at pain scoring and reviewing pain’ ‘Secondary care has an advantage over primary care with this, as in primary care they go for weeks without seeing the patient’

‘Legislation has been detrimental to non medical prescribing’

Dr Karen Stenner Lecturer University of Surrey continued the morning sessions with a presentation on 'Nurse/Non-Medical prescribing for pain: where are we now?' Dr Stenner discussed:

  • what are nurses prescribing for pain?
  • prescribing for post-operative pain, acute pain, chronic pain and long term conditions, cancer pain, crossover pain
  • the range of pain management prescribed
  • improving pain outcomes
  • issues around prescribing of controlled drugs

Dr Karen Stenner Full Presentation

In her presentation Karen Stenner Stated: 

‘Pain always comes up as one of the main topics for nurses’ ‘Pain is one of the most common conditions which non medical prescribers are involved with’

‘The key benefit of prescribing pain is always speed and convenience of being able to get the patient the pain relief they need’

‘Continuity of high level professional care is very important. The more communication you have with GP’s etc means that everybody is performing at a higher, safer level’

‘Prescribing is opening the gates of innovative practice, these are very exciting times’

‘Regarding education and training there are CPD needs out there’ 82% of nurse prescribers felt adequately trained, 8.6% did not and 9.5% were unsure’

Abstract of Karen Stenner's presentation:

This presentation provides an overview of the research on non-medical prescribing for pain in the UK. Until recently, little was known about the profiles or prescribing practices of nurses and other non-medical prescribers involved in treating pain. Drawing on findings from surveys1,2,3 and qualitative work4, the talk will indicate the extent to which non-medical prescribers are involved in prescribing medications for pain, the settings in which they work and the types of medications prescribed. It will also summarise the benefits reported by nurses who prescribe pain medication and identify issues raised.   

Key messages

  • Nearly half of all nurse prescribers surveyed are involved in prescribing for pain
  • Non-medical prescribers who prescribe for pain work in a wide range of service areas, including first contact, primary care and specialist pain services
  • Most nurses surveyed estimated that they prescribe between 1 and 10 items for pain per week, however pain specialist nurses prescribe on average 19 items per week
  • A majority prescribe for patients with acute pain and most commonly prescribe NSAIDs
  • Opioid analgesics are more often prescribed by specialist pain nurses with high levels of training and experience
  • There are ongoing training needs for NMPs who prescribe for pain

Karen Stenner's Biography

Karen Stenner (PhD, BSc) is a lecturer in the School of Health Sciences at the University of Surrey, Guildford, UK. Her research has explored the use of prescribing by nurses and other health care professionals with a focus on developments around prescribing for pain and long term conditions. She is interested in the role that non-medical prescribing can play in improving health service delivery. Karen is currently working on a Department of Health funded evaluation of physiotherapist and podiatrist independent prescribing, a collaborative project with the University of Brighton.

Dr Steve Gilbert Consultant in Anaesthetics & Pain Management Fife Integrated Pain Management Service, Queen Margaret Hospital & Chair, Learning & Development Subgroup of National Chronic Pain Improvement Group spoke during the afternoon on 'prescribing for chronic pain'. Dr Gilbert's presentation included the following topics:

  • ensuring a whole person approach and shared decision making
  • tips and advice for nurse/non-medical prescribers for chronic pain


Abstract of Steve Gilbert's presentation

This presentation will provide clarity around the definition, diagnosis and management of chronic pain – how to integrate the biological component, including prescribing, with the psychosocial components of pain & to be able to explain this to patients.

It is important to be able to understand & explain the differences between acute & chronic pain. The analgesic ladder, which may be helpful for acute pain is often less useful for chronic pain. The effect of medication should be assessed & balanced against side effects. It is also important to engage people with chronic pain in becoming an active partner in patient centred care. This requires improved health literacy and supported self-management.   

Learning Outcomes

  • Understand the Neurophysiology of pain
  • Identify Psychosocial risk factors       
  • Be able to explain pain & medically unexplained symptoms to patients
  • Understand rational use of analgesics & adjuvants
  • Motivate patients to take a self management approach     

Dr Steve Gilbert's Full Presentation

Steve Gilbert's Biography

Steve Gilbert has been a Consultant in Anaesthetics & Pain Management in Fife since 1997. He was seconded to the post of National Lead Clinician for Chronic Pain between 2011 -14. He has an interest in the early identification & management of chronic pain, pain management education, children’s chronic pain & in developing online resources for patients & professionals.

Future events of interest

Effective Non-Medical Prescribing in End of Life Care
Friday 16 September
Hallam Conference Centre
Effective Nurse Prescribing in End of Life Care
Friday 16 September
Hallam Conference Centre
Non-Medical Prescribing in Mental Health
Tuesday 27 September
Hallam Conference Centre
Nurse Prescribing in Mental Health
Tuesday 27 September
Hallam Conference Centre

8 July 2016


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