Aston University researcher to help uncover hidden impact of painkiller overuse among older people

• The HOPE-AO project led by the University of Plymouth will look at the potential harms of overprescribed pain medication in older people in the UK
• Aston University’s Professor Ian Maidment will bring his expertise in pharmacy and work with patient groups on medicine optimisation
• The project has been funded by the National Institute for Health and Care Research (NIHR)

A new study led by the University of Plymouth will explore chronic pain prescribing in older adults across the UK, with the aim of understanding whether current treatments and processes meet their needs.

The HOPE-AO: Helping to Optimise Pain control in the Elderly experiencing Analgesic Overprescribing project is being supported by the National Institute for Health and Care Research (NIHR) and includes Aston University’s Professor Ian Maidment. It will investigate whether certain groups of the older population are more likely to have analgesic (pain relief) medication overprescribed to them, and any side effects or other harms these medications can pose if taken for long periods.

It aims to identify alternative treatment solutions to reduce the use of unnecessary pain medicines, working with patients to develop a list of acceptable strategies that could be tested and implemented across the UK.

Around 4m older people across the UK live with varying degrees of chronic pain as a result of conditions including arthritis, diabetes or frailty. While some people benefit from pain relief medicines, many end up receiving long-term repeated prescriptions – for medications ranging from paracetamol and ibuprofen to opioids and antidepressants – for weeks, months or years at a time.

The project is being led by researchers from the University of Plymouth, working with colleagues at the University of Exeter, Aston University, University of Aberdeen and the North East London Foundation NHS Trust. It is funded by through a Programme Development Grant from the National Institute for Health and Care Research (NIHR).

The project team comprises experts in the care of older people – including healthcare researchers, nurses, consultants, GPs, pharmacists and psychiatrists working across the UK – as well as medical statisticians and health economists. It also involves an advisory group of patients with lived experience of receiving repeat prescriptions for pain medication.

During the project, the team will speak to patients aged 65 and over with a history of chronic pain for which they are taking, or have taken, medication and families who cared for and supported relatives with chronic pain. They will also speak to healthcare professionals who are either prescribing or supporting older adults taking medication for chronic pain management.

Alongside this work, the team will analyse anonymised healthcare data to understand more about older adults who are prescribed medication for chronic pain. This includes patterns in prescribing, health and demographic factors associated with pain medication use, and potential health outcomes, and will help identify those likely to benefit most from support.

Professor Maidment, from Aston Pharmacy School, will bring his expertise in pharmacy, medication use in day-to-day clinical practice and working with diverse groups of patients to support medication optimisation.

He said:

“From my experience in community pharmacy, the use of pain medicines is very common in older people. We need to work with older people to understand how we can help older people to use other potentially safer approaches.”

Patricia Schofield, professor of clinical nursing at the University of Plymouth and one of the study’s chief investigators, said:

“Very often, older people are told by a doctor that the most effective means of treating a health condition is through some form of pain relief. But they often don’t get any form of follow-up appointment and, as a generation, are less likely to seek one as they either feel pain is part of the ageing process or they don’t wish to be seen as a burden. The result is that they end up getting repeat prescriptions, potentially for pain medications they no longer need and also at significant cost to the NHS.

“This study will give us a clearer understanding of the scale of the issue which we can use to develop ways of benefitting patients and their families, and the healthcare professionals working to treat and support them.”

Victoria Abbott-Fleming MBE, founder of the charity Burning Nights CRPS Support, is the chair of the Patient and Public Involvement and Engagement group for the HOPE-AO study. It will be made up of several adults over the age of 65 who live with chronic pain and have received repeat prescriptions for pain medication. Victoria has herself lived for more than 20 years with a chronic pain condition, Complex Regional Pain Syndrome (CRPS), and set up Burning Nights to support those affected by it on a day-to-day basis and their families. She is also chair of the Expert Patient and Carer Committee at the British Pain Society.

She said:

“I’m excited to support this study that places the voices of older adults and their carers at the heart of pain management. All too often, those living with chronic pain – especially older adults – are prescribed medication without regular review or consideration of alternative approaches. This study is a vital step towards more informed and balanced care, helping ensure that older people living with chronic pain are not just treated, but truly heard and supported.”