How a physiotherapy-led, pharmacist-supported model helped patients improve function, reduce medication reliance and regain confidence in self-management
Key Outcomes
1,346 Patients Identified | 66 Medicines Optimisation Outcomes Delivered | 29% Clinically Significant Improvement | 92% Would Recommend the Service
The Challenge
Persistent pain is one of the most common reasons for repeat GP appointments and long-term prescribing of opioids and gabapentinoids.
Whilst medication can play an important role in managing symptoms, many patients continue to experience reduced function, poor quality of life and ongoing reliance on medicines despite years of treatment.
Burnley West Primary Care Network partnered with Promni Health to pilot an innovative Persistent Pain Medicines Optimisation Service designed to address the drivers of persistent pain, improve patient outcomes and support safer prescribing.
The Solution
The service combined specialist persistent pain physiotherapy with collaborative pharmacist support to create an integrated pathway focused on:
- Understanding the individual’s pain experience
- Improving confidence in self-management
- Supporting function and quality of life
- Addressing barriers to medication reduction
- Enabling safe medicines optimisation
Rather than focusing solely on medication reduction, the service aimed to create the conditions for successful and sustainable change through education, rehabilitation and behaviour change.
By addressing the drivers of persistent pain, patients were better able to engage with conversations regarding medication reduction whilst improving confidence in managing their condition.
The Impact
Population Reach
- 1,346 patients identified through opioid and gabapentinoid prescribing searches
- 1,239 patients clinically appropriate following screening and triage
- 996 patients proactively engaged
Medicines Optimisation
- 66 medicines optimisation outcomes delivered
- 22 medication cessations achieved
- 44 medication dose reductions achieved
- 77 patients referred for medication review
Patient Outcomes
What is MSK-HQ?
MSK-HQ is a validated NHS patient-reported outcome measure used to assess how musculoskeletal conditions affect everyday life. It captures important aspects of health and wellbeing including mobility, physical function, sleep, fatigue, emotional wellbeing, understanding of a condition and confidence in self-managing symptoms.
This means improvements in MSK-HQ scores reflect more than changes in pain levels alone, providing a broader measure of improvements in quality of life and day-to-day function.
- Average MSK-HQ improvement of 2.9 points
- 29% achieved a clinically significant improvement in MSK-HQ
- Patients reported improvements in mobility, activity levels, sleep and overall quality of life
Patient Experience
- 92% would recommend the service
- 96% felt listened to and understood
- 96% felt involved in decisions regarding their care
- 100% reported treatment goals were clearly explained
Improving Outcomes Whilst Reducing Medication
A common concern when reducing long-term pain medication is that symptoms may worsen.
However, analysis of patients with linked medicines optimisation and outcome data demonstrated that:
41% achieved a clinically significant improvement in MSK-HQ score whilst progressing through medicines optimisation pathways
This exceeded the overall pilot average and suggests that patients reducing or stopping long-term analgesic medication were able to maintain and often improve functional outcomes and quality of life when supported through specialist pain assessment, education and rehabilitation.
The findings demonstrate that medicines optimisation can be achieved alongside meaningful improvements in day-to-day function, mobility and confidence in self-management.
What Patients Told Us
“I am feeling better. I am able to walk more, stand for longer and my sleep has improved. Thank you for your advice, support and exercises.”
“In just two sessions, I received more information and support regarding my medication and the impact it was having than I did over the previous two years. I feel listened to and have noticed gradual improvements in my daily life and quality of life since reducing my medication.”
“After being referred to the pharmacist, my medication was changed from gabapentin to pregabalin. I am feeling more than 50% better, sleeping better and doing more walking and activities. This is helping me while I wait for my total knee replacement.”
”I felt a bit nervous about cutting or reducing medication when I spoke with you, but I felt the support and help you offered, and I managed to reduce my medication. That made a difference to my mood, and I am enjoying more daily activities, especially spending time with my grandkids. Thank you for your help and support.”
”I was not positive about the service and what you have to offer, but since our first appointment, I felt heard, and I decided that I would like to follow the plan you offered me. Now, I feel that I can do more with less pain, sleep better, and spend time with the people I love and care about.“
“I have started tapering my medication, and so far I feel that it is working. You were informative and really helpful throughout our meetings.”
These testimonials demonstrate the impact of the service beyond pain reduction alone, highlighting improvements in confidence, self-management, function and wellbeing.
Wider Impact
Alongside improved patient outcomes, the pilot delivered an estimated £2,600–£3,700 in annual direct prescribing savings, with further benefits expected as patients continue through active deprescribing pathways.
The wider value of the service extends beyond prescribing costs and includes:
- Reduced dependency risk
- Reduced prescribing burden
- Reduced medication monitoring requirements
- Improved patient confidence and self-management
- Potential release of GP and pharmacist capacity
- More sustainable use of primary care resources
Looking Ahead
The Burnley West pilot demonstrated that patients can successfully reduce or stop long-term opioid and gabapentinoid medication whilst improving function, mobility and quality of life.
By combining specialist persistent pain physiotherapy with pharmacist-led medicines optimisation, the service delivered meaningful clinical outcomes, high patient satisfaction and sustainable prescribing improvements.
The model provides a scalable approach for Primary Care Networks seeking to address persistent pain, reduce inappropriate prescribing and support more sustainable use of NHS resources.
“I just wanted to take this opportunity to thank you for the pain service which you provide for Burnley West Primary Care Network – this pilot has already shown positive engagement from patients who often have complex persistent pain needs and may not previously have accessed this level of support. Feedback from patients has been encouraging, particularly around feeling heard, understanding their medication better, and improving day-to-day function and quality of life. The service has integrated well with the PCN and provides a proactive approach to medicines optimisation and persistent pain management.” Operations Manager, Burnley West PCN
