Tramadol, pregabalin and diazepam prescriptions fall
· BBC NewsCatherine Moore
BBC News NI
Prescriptions of some addictive medications used to treat chronic pain and anxiety have fallen over the past 10 years in Northern Ireland, BBC News NI can reveal.
Doctors welcomed the reduction in the use of tramadol, pregabalin, and diazepam, but they also stressed that more needed to be done to ensure people could access other pain treatments more quickly.
Tracey Latimer started taking pregabalin to deal with arthritis and knee pain, but she has come off the painkiller after attending a pain management course.
“It’s about understanding your pain and building a toolkit around what you can do," she told BBC News NI.
"If you’re kind to your body, maybe your pain will be kind to you.”
Living well with pain
A heart attack in 2014 set off a challenging series of events for Tracey, and she went on pregabalin in 2018 after damaging her knee in an accident at cardiac rehab.
An initial plan to operate was changed after her consultant discovered she had arthritis and would eventually need a new knee.
Tracey said at the time she was “completely lost”, but things changed when her mother saw an advert for a six-week Versus Arthritis pain management course.
“You learn tools and techniques to help you live well with pain,” she said.
“If I was to walk up stairs, I can’t really do it, I have to haul myself up.
“But I use distraction techniques—counting back from 100 in threes or naming flowers beginning with A, B, and C—so I’m concentrating on something else.
“Now that I’m off the medication, my pain isn’t any worse than it was when I was taking it."
New figures from the Department of Health (DoH), released to BBC News NI under a freedom of information request, reveal tramadol prescriptions have fallen by 45%, from 66,167 in 2014 to 36,648 in 2023.
A similar trend can be seen in pregabalin prescriptions, which fell from 36,105 in 2014 to 25,783 in 2023—a 29% decrease.
The number of patients prescribed diazepam has also fallen by 13%, from 101,663 in 2014 to 88,717 in 2023.
According to the DoH, the decrease is a result of several factors.
These include legislative changes over concerns about abuse, prescribing guideline changes, increased efforts to reduce potentially inappropriate prescribing and greater promotion of alternative strategies such as pain support programmes and counselling.
'A way to go'
Dr Frances O’Hagan, chairwoman of the BMA’s Northern Ireland general practitioners committee, welcomed the fall in prescriptions but added that the "consistently slow path of reducing prescribing numbers shows how difficult and challenging this is to achieve".
"Unfortunately, because patients end up being on waiting lists for possibly years for treatment, we can find they need stronger medication to help them cope with their pain," she said.
She emphasised that pregabalin, tramadol, and diazepam were "very addictive," and GPs were working with patients to reduce prescriptions "to minimise the potential complications that come from long-term use."
Dr Ursula Mason, chairwoman of the Royal College of General Practitioners Northern Ireland, said the drop in prescribing shows that mental health support, physiotherapy, and pain management programmes “can make a big difference to patients” with chronic pain and anxiety.
She said there is still "a way to go", but GPs have been working with patients to explore alternative methods of managing these conditions.
According to HSCNI it has been estimated that about one-in-five people in Northern Ireland live with long-term pain.
Reports have also indicated that the prevalence of mental health problems in adults in Northern Ireland is 25% higher than in England.
This is associated with both greater levels of deprivation and the legacy of the Troubles.
Sara Graham, head of Northern Ireland at Versus Arthritis, said the organisation's pain management programmes helped people "develop coping strategies that massively improve [their] quality of life".
“People often find that pain medications cause side effects or aren’t helpful enough, and while joint replacement surgery can be life-changing, there are long waits for treatment," she said.
"Our programmes can help people manage their condition while they wait.”
Another initiative, the Managing the Challenge Programme (MTC), is delivered by Action Mental Health in the Western Health and Social Care Trust area.
Its coordinator David Tierney said the programme taught people skills to help them "deal with the pain and the associated fatigue, anxiety, and stress that often accompanies their condition".
"We encourage participants to be clear about why they are taking medication, to take it as prescribed and get it reviewed regularly," he added.
"After attending the programme, many have reported being able to reduce the amount of medication they use and deal more effectively with flare-ups in pain."
Weighing up the side effects
After completing the Versus Arthritis course, Tracey did a gradual medication reduction programme with her doctor.
Ultimately she felt the side effects of the medication—increased appetite and feeling lethargic and emotional—were “more troublesome than the relief” provided.
“A pharmacist explained to me that with pain medication the most you can expect is between 30% and 50% relief, so you have to decide if the side effects are worth the relief," she said.
Tracey now facilitates a Versus Arthritis pain support group.
“I want to get everyone with chronic pain to know there are options," she said.
"Medication has a part to play, but it isn’t the be all and end all."