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Ian Hamilton need not be so downcast about alternatives for reducing gabapentinoid overuse.
Kairos Rehabilitation, a registered charity, is a GPwSI-led Pain Management Clinic commissioned by Circle MSK for Greenwich CCG. We have furnished Dr Hamilton’s call for ‘more support’ with gentle pain-free therapies and time-honoured ease of access, continuity of care and personal touch. A significant pull away from clinical services is achieved by a choir and groups for art, wool-work and gardening. Patients soon become contributors and have educated us on the way. Their despair is not just related to ongoing pain and little promise of relief, but more to going unacknowledged as individuals and, often unwittingly, being held away from their own path of personal development.
When hope is restored, inherent creativity engaged and new friends are in the offing - all accompanied by a modest reduction in symptoms, it becomes obvious to all that increasing hefty analgesics up will bring no gain. To everyone’s delight, succeeding in reducing them improves not only physical and mental health but self-confidence for still further engagement and progress.
In a preliminary retrospective evaluation (Wright E et al. J Pain Manage 2017;10(2):149-159) of the project's first 30 patients, follow up data was gathered, on average, after each patient had been discharged for 19 months. Despite initial high levels of disability, statistically significant improvement in mean EQ5D-3L health status, median average pain intensity on BPI and an overall reduction in clinically significant depression. Repeat analgesic and psychotropic medication reduced by 46%. Specialist OPD attendance was reduced by 51%, specialist therapy attendance by 86%.
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