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Pain affects large numbers of people and independent pharmacists have an important part to play in helping them manage their symptoms. But deprescribing can play an important role, as Steve Titmarsh explains…

Pain UK estimates that around 28 million people in the UK live with pain.² So it is perhaps not surprising that sales of OTC analgesics, at around £865 million in 2025, made them the largest sector of the £3.76 billion UK OTC medicines market in 2025, according to the PAGB.¹ 

The UK Clinical Pharmacy Association (UKCPA) says pharmacists have a variety of roles in pain management that can include:³ 

– Collaborating with healthcare professionals to manage chronic disease and extreme pain.

– Providing primary support for prescription and medication queries relating to pain.

– Assisting in clinical medication reviews and providing recommendations for primary care providers.

– Ensuring appropriate and timely referrals to healthcare professionals for patients with pain conditions.

– Conducting reviews for prescribing practice and implementing changes based on relevant guidance.

– Providing training to healthcare professionals on new findings in pain management.

– Assisting with the integration of pain management services in the community and hospital pharmacies.

Independent Community Pharmacist asked Dr Emma Davies, principal pharmacist – pain, analgesic stewardship and harm reduction at Cwm Taf Morgannwg University Health Board and a member of the British Pain Society, for her thoughts on how independent community pharmacists can support people enduring pain. 

Management strategies 

Dr Davies said that independent pharmacists are well placed to support people with mild-to-moderate pain because they are accessible, trusted and often have long-standing relationships with their patients.

She advised that they should start with good assessment: understanding the likely cause of pain; how long it has been present; what the patient has tried; what medicines they are taking, and whether there are any red flags requiring urgent referral.

For short-term pain, pharmacists can advise on appropriate use of paracetamol, topical non-steroidal anti-inflammatory drugs (NSAIDs), or oral NSAIDs where suitable.

These should be in conjunction with non-medicinal measures such as heat, ice, activity modification and gentle movement. Dr Davies added that Clinical Knowledge Summaries (CKS) from the National Institute for Health and Care Excellence (NICE) emphasises safe analgesic selection for mild-to-moderate pain, including attention to maximum daily dosages and NSAID risks.⁴

For chronic pain, Dr Davies said the focus should move beyond simply supplying medicines.

Pharmacists should ask about function: what the pain is stopping a person doing; whether sleep or mood are affected, and what goals matter to the patient. Pain is rarely just a physical symptom; it is influenced by activity, confidence, sleep, mood, work, relationships and wider social factors.

Independent pharmacists can therefore give advice on pacing, movement, weight, sleep, mood and local support services. They also have a role in identifying when GP or other referrals are needed.

The key message is that mild-to-moderate pain management should be safe, proportionate and person-centred. Medicines can help, but they should sit within a broader plan aimed at maintaining function and preventing escalation, Dr Davies said.

Use prescribing skills to improve health outcomes

Independent pharmacist prescribers can add real value by providing timely, clinically appropriate care close to where patients live, said Dr Davies.

In independent pharmacies this is particularly important, because many patients have regular contact with the same pharmacist and may disclose problems earlier than they would in a GP consultation, Dr Davies explained.

Prescribing skills can be used to improve outcomes by ensuring that analgesics are appropriate, safe and reviewed.

This includes choosing the right medicine for the right pain presentation, avoiding unnecessary escalation, checking renal function and gastrointestinal or cardiovascular risk before NSAID use, reviewing drug interactions, and ensuring that older or frailer patients are not exposed to avoidable harm, Dr Davies commented.

Independent prescribers can also support medicines optimisation for people taking analgesics.

This may involve rationalising duplicate therapy, reviewing combinations such as opioids with gabapentinoids or benzodiazepines, identifying adverse effects, and communicating concerns to a patient’s GP or wider care team.

Dr Davies pointed out that the Medicines and Healthcare products Regulatory Agency (MHRA) recently strengthened warnings around addiction, dependence, withdrawal and tolerance for gabapentinoids, benzodiazepines and Z-drugs, reinforcing the need for careful review where these medicines are used, particularly alongside opioids or alcohol.⁵

Used well, prescribing should not simply mean issuing more medicines, Dr Davies commented.

“It should mean better clinical decision-making: starting medicines only where there is a clear indication; reviewing whether they are helping; stopping medicines that are ineffective or harmful, and supporting patients to access non-drug approaches where these are more likely to improve long-term outcomes.”

When to deprescribe?

Dr Davies felt that independent pharmacists have an important role in identifying when opioid medicines may no longer be helping or may be causing harm.

However, they should not usually reduce or stop opioids unilaterally unless this is within an agreed prescribing arrangement and the patient’s main prescriber is aware and, ideally, involved.

The Faculty of Pain Medicine of the Royal College of Anaesthetists agrees that pharmacists have an increasing role within or alongside pain management services in all sectors and should lead on pharmacological management guideline development and safety initiatives to reduce the harm caused by opioids.⁶ 

Although opioid reduction can appear straightforward, in practice it can be complex. Patients may experience withdrawal symptoms, increased pain, anxiety, sleep disturbance, distress, or loss of confidence, Dr Davies explained.

For that reason, opioid deprescribing is best done in a supportive environment, with a clear plan, regular review, and access to help if a patient starts to struggle.

Dr Davies added that independent pharmacists can add real value by recognising when a review is needed.

This may include situations where pain remains severe despite opioids, function has not improved, doses are escalating or adverse effects are present.

Community pharmacists should also be vigilant to investigate high-risk combinations such as opioids with gabapentinoids, benzodiazepines, Z-drugs, alcohol or other sedating medicines.

In these cases, the pharmacist’s role is often to start the conversation, explore whether the medicine is still helping, assess risk, and communicate clearly with the GP, pain service, or other prescriber.

Where appropriate, they can then support a shared tapering plan, provide regular follow-up, monitor withdrawal effects and reinforce self-management strategies.

It is important to help patients understand that reducing opioids is not about abandoning them in pain but about improving safety, function and quality of life, Dr Davies explained.⁷

Community pharmacists have increasing opportunities to contribute to this work alongside primary and secondary care colleagues.

Dr Davies said there are already examples of pharmacists providing excellent support for analgesic withdrawal in community pharmacy settings – in conjunction with local pain services or as part of primary care-led initiatives.

The key principle is that pharmacists should not operate in isolation. Opioid deprescribing is safer and more effective when patients have a team around them – and when pharmacists have clinical support, governance and clear routes for escalation.

This allows independent pharmacists to contribute their medicines expertise while ensuring patients are properly supported throughout what can be a difficult process, Dr Davies said.

Systemic bias makes women turn to AI for help with pain relief

New data from Nurofen reveals pain dismissal remains a persistent reality for women in the UK and is driving millions towards unverified health information, including AI, for answers.

The research, released in Nurofen’s fourth annual Gender Pain Gap Index Report, finds 53 per cent of women have had their pain ignored or dismissed.

Nearly three quarters aged 18-24 felt their pain was ignored or dismissed, almost double the rate of women over 55 (40 per cent). Almost half reported becoming reluctant to seek help again and 35 per cent said their trust in the medical system had been impacted.

Three in four women who felt their pain was dismissed sought help from alternative sources, with 91 per cent acting on the advice they found.

One in five asked AI such as ChatGPT for health information, despite documented accuracy concerns, while 35 per cent agreed social media has made them question their doctor’s advice.

Half of women aged 18-34 sought help online after being dismissed, compared to just 19 per cent of those over 65.  

*Nurofen’s 2025 Gender Pain Gap survey was conducted by OnePoll among 5,000 UK adults in November 2025. 

References  

1. PAGB. PAGB Highlights 2025 (www.pagb.co.uk/content/uploads/2026/03/PAGBs-Highlights-Report-2025.pdf; accessed May 2026).

2. PainUK (https://painuk.org; accessed May 2026).

3. UK Clinical Pharmacy Association (UKCPA). Pain (https://ukclinicalpharmacy.org/communities/pain; accessed May 2026).

4. Clinical Knowledge Summaries. Analgesia – mild-to-moderate pain (https://cks.nice.org.uk/topics/analgesia-mild-to-moderate-pain; accessed May 2026).

5. Medicines and Healthcare products Regulatory Agency (MHRA). MHRA strengthening dependency and addiction warnings on medicines used to treat pain, anxiety, and insomnia (www.gov.uk/government/news/mhra-strengthening-dependency-and-addiction-warnings-on-medicines-used-to-treat-pain-anxiety-and-insomnia; May 2026).

6. Faculty of Pain Medicine of the Royal College of Anaesthetists. Pharmacists and safe opioid prescribing (https://fpm.ac.uk/opioids-aware-best-professional-practice/pharmacists-and-safe-opioid-prescribing; accessed May 2026).

7. Pain Concern. Airing Pain 137: Pharmacists and Chronic Pain (https://painconcern.org.uk/pharmacy-prescribing; accessed May 2026).