BBC Radio 4 - Pregablin and gabapentin misuse

Perscriptions for nerve drugs, pregablin and gabapentin have risen dramatically in recent years and at the same time, concerns about abuse. Former prisioner and addict "Patrick" tells Dr Mark Porter that "gabbies" or "pregabs" are drugs of choice in jail and Dr Iain Brew, a GP who works in prisons, says misuse is a growing problem and there are examples of doctors being pressurised into prescribing them. Dr Cathy Stannard, consultant in pain medicine at Southmead Hospital in Bristol, chaired an expert group that drew up new prescribing guidelines for pregablin and gabapentin and she tells Mark that more attention needs to be paid to emerging evidence of misuse.

Please click on the resource link below.

Primary Care Offer Masterclass


Ellen Rule and Dr Cathy Stannard

  • Welcome and Background to the Masterclass

Dr Helen Makins

  • Our Current Pain Service: what works well and what could work better?

Dr Cathy Stannard

  • Introduction to Complex and Persistent Pain, Role of Medicines and Pain Related Evidence

Session Aims:

  • The various types of pain and how they differ in presentation, trajectory and response to treatment
  • The challenges of living with and managing complex pain
  • How a better understanding of complex pain helps us focus our efforts appropriately to support  patients to live well with pain.
  • The role of medicines in complex pain management
  • How we use evidence in pain management

Discussion Points:

  • What can be prescribed? What works?
  • What does Evidence support?

Dr Kate Seddon

  • Recognising complexity and understanding your own feelings in consultations

Acute and persistent pain have traditionally been distinguished by the duration of symptoms, however, some pain presentations can be identified as complex at first consultation. Persistent pain is frequently accompanied by other bodily symptoms and emotional co-morbidities. It is well demonstrated that GPs find persistent pain one of the most challenging conditions to manage and clinicians may have negative perceptions of patients with refractory persistent pain. Patients with pain are often distressed and this further challenges the clinician in his/ her therapeutic role. Understanding how we feel can support a therapeutic consultation and help us to avoid offering treatments that are unlikely to help.

This interactive session will explore features in the presentation that may indicate that the patient has complex pain and why we sometimes feel the way we do.

Discussion Points:

  • What des complexity in pain look like?
  • Understanding why we feel what we feel
  • How can negative feelings be understoood? 


Dr Kate Seddon

  • Managing difficult conversations in consultations

Developing a shared understanding of the complexity of pain can be challenging, particularly if patient expectations aren't being met and clinicians feel unable to help. During this interactive session we will explore how we might manage difficult conversations with patients who are frustrated, disabled and ditressed. Building on some of the ideas already introduced earlier in the session and in Masterclass Session 1.

Session Aims:

  • Learning to say 'No' when treatments are not in the patient's best interest.
  • Increase confidence to manage the patient that never gets better.
  • Inform us on how you feel the Gloucestershire pound would be best spent on Pain.

Dr Cathy Stannard

Alternatives to pain treatments: setting aside pain intensity and supporting wellbeing for patients with complex pain. It is helpful to know where our county sits in relation to similar communities with respect to pain prescribing and the session will start with an overview of prescribing of medicines for persistent pain. The rest of the session will build on themes of the first masterclass, reinforcing the central theme of "First, Do No Harm" and will then focus on how we think about complex pain presentations in a more holistic way to help patients live better by addressing many of the other difficulties which co-occur with complex pain.

Session Aims:

  • Re-explore thd idea of "First, Do No Harm".

Build confidence in using evidence when making shared treatment decisions.

Encourage the use of holistic needs assessments to support patients with persistent pain.

Explore commonly expressed barriers to de-prescribing and how to overcome these

Dr Polly Ashworth

  • Introduction to the Pain Management services

Session Aims:

  • Increase understanding of the range of complexity of patients with persistent pain
  • Create awareness of self-management resources for patients with persistent pain

Ellen Rule

  • The Gloucestershire approach to non-medical interventions for both medical and non-medical needs
  • What might Arts & Culture offer people living with pain and the people supporting them?

Session Aims:

  • Increase understanding of the the Gloucestershire Social Prescribing and cultural Commissioning offer.