Evaluating psychological and social interventions

Dr Soraya Mayet, Consultant Psychiatrist Addictions Specialist at Humber Teaching NHS Foundation Trust, and Honorary Senior Lecturer at Hull and York Medical School, has been working on a number of NICE (National Institute for Health and Care Excellence) guidelines, which look at how addictions issues may interact with other physical issues in the body.

Dr Soraya Mayet, who is also the Consultant Psychiatrist for the East Riding Partnership, a community addiction service serving the local population, has been working on three NICE guidelines. This includes assessing the impact of addictions on medications prescribed for chronic pain, low back pain and sciatica and medical cannabis.  

“NICE guidelines are evidence-based recommendations for health and care in England. They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings. Nice guidelines help health and social care professionals to: prevent ill health, promote and protect good health, improve the quality of care and services, adapt and provide health and social care services.” 

Source: https://www.nice.org.uk/

NICE guideline groups will have members including specialists, lay people, carers and patients. NICE guidelines are produced using an evidence-based medicine and cost effectiveness approach. Research studies are collated and analysed looking at the effectiveness of the intervention and whether this is worth the costs.  

Whilst involved on the NICE guideline group, Dr Soraya Mayet has reviewed the evidence and contributed to making recommendations for treatment interventions. In particular, Soraya discussed issues such as addictions and overdose with opiates, pregabalin or gabapentin, which are commonly prescribed for pain.

The NICE guideline evidence review showed that opiates, pregabalin and gabpatentin, can cause more risks than benefits for people with chronic pain. It is worrying to note that these prescription medications are linked with increasing numbers of deaths. In addition, people prescribed these medications may become dependent on the medications unknowingly, as their body becomes tolerant to the effects. This can actually cause breakthrough pain, as the medication effects wear off, which is related to drug withdrawals.

It is also important to be aware that some people may take these prescribed medications to get a desirable effect which can lead to abuse of the medication. Due to the risks of these medications, it is important for all patients prescribed these medications to have a regular medication review by their Doctor or Non-Medical Prescriber.

The NICE guidelines on lower back pain and sciatica and medical cannabis are now published. The chronic pain guidelines are out to consultation. The NICE guidelines do not recommend opiates, pregablin or gabaptenin, for chronic pain.

What is interesting, however, is that, because these medications are and have been prescribed in the past, this does not mean that they can simply be stopped. Withdrawals are very serious and coming off of these drugs has to be done in a controlled and careful way. Therefore these NICE guidelines suggest that Doctors and Non-Medical Prescribers carefully review these medications, discuss the risks/benefits with patients, and agree a plan forward. This may include looking at alternative ways for managing the pain. For patients starting a reduction plan, this should be a gradual reduction, to prevent severe withdrawals. Patients may have been prescribed these medications for many years and so extra support with the reductions can be really important.

If you would like to learn more about these NICE guidelines, you can access them here:

• Chronic pain: assessment and management. In development [GID-NG10069] Expected publication date: 20 January 2021 https://www.nice.org.uk/guidance/indevelopment/gid-ng10069

• Low back pain and sciatica in over 16s: assessment and management NICE guideline [NG59] Published date: 30 November 2016 Last updated: 22 September 2020 https://www.nice.org.uk/guidance/ng59

• Cannabis-based medicinal products NICE guideline [NG144] Published date: 11 November 2019https://www.nice.org.uk/guidance/ng144

For those who may be struggling with prescription medication dependence in East  Riding, Humber Teaching NHS Foundation Trust has recently been commissioned to provide a support service by East Riding Local Authority and Clinical Commisioning Group. The new service, Optimise, is a psychosocial intervention service which supports patients to gradually come off medications that can cause dependence, in a safe way. If you would like to find out more, please speak to your GP.

If anyone has any difficulties related to any of the areas discussed in this article, please contact your local services. Optimise or your GP are there to help support you.