Palliative or therapeutic use of opioid analgesics is now a well-accepted approach to managing pain in the UK.
It is not only used to manage acute pain and chronic pain in people who are unable to tolerate opioids but also to help with conditions like chronic fatigue, obesity, asthma and arthritis.
The government announced plans to introduce a Palliatives Act in 2018.
This will mean that the use of opioids will no longer be a criminal offence in England and Wales, but it will only apply to those with chronic pain, such as pain in chronic pain or those suffering from serious or life-threatening conditions.
Palliative use of the drug will be regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA), which is responsible for regulating the drugs.
The Palliatively Ill in Pain (PILP) scale is a rating system for the severity of pain experienced by people with chronic conditions.
The scale is based on the number of times patients have used a drug over a specified period of time and is designed to assess the extent to which pain is controlled by a pain management programme, with a score ranging from one (not useful) to three (very useful).
The PILP scale is the first of its kind in the world and has been developed by the British Pain Society and is based upon a patient’s history and experience of pain.
Dr Richard Mair, a senior consultant in pain management at the University of Oxford, said:”Palliatives have been around for quite some time, and have been shown to be useful in a variety of conditions, including chronic obstructive pulmonary disease (COPD) and pain associated with cancer and chronic back pain.”
However, the PILPs scale has never been used to assess pain in severe conditions like COPD, so it is very important that it is used in such cases.
“The PIRP scale also recognises the need for long-term pain management and we believe that PILs scale should be used as a benchmark for pain management.”
In a recent review of all the evidence, researchers at the Royal College of Surgeons concluded that Palliates scale was “very useful” and was “generally recognised as an effective tool for pain patients”.
However, they also pointed out that there were some caveats to consider, including that there are limitations to the assessment, that PIRPs scale does not distinguish between chronic and acute pain, and that Pils are not a suitable measure of pain intensity.
The experts added that there was also concern about the accuracy of the scale, which can result in patients being judged to have been very lucky to receive a pain medication that was effective at reducing their pain levels.
They recommended that the PIRPS scale should only be used for patients who have been using opioids for at least a year, and should be revised to include those who have used opioids for more than two years.
The UK government’s Palliate Treatment Scheme aims to improve the availability of opioids for chronic pain and cancer patients by introducing a PILPS scale that can be used to measure the quality of care provided to those who are suffering from pain.
The scheme aims to assess how effective opioids have been for the treatment of chronic pain by comparing patients who received opioid analgesia over a 12-month period with those who did not, with the aim of helping patients improve their outcomes and quality of life.
The number of people who have taken opioids has risen from a few hundred in 2016 to more than 1,000 people today.
The British Medical Association (BMA) has described the PALS scale as “a powerful tool for improving patient outcomes, particularly for those with severe pain and for cancer patients”.
Dr Mair said: “There are some limitations to using the Pils to assess acute pain as it is a difficult measure to assess because of the lack of data.
However, we believe it is useful in the context of chronic conditions where patients are having a difficult time with opioids.”
Dr John Fennell, chief executive of the National Pain Society, said the PILS scale should not be used solely for assessing pain, but should also be used when people are receiving opioids for a long time.
He added: “It is important that we use the PPL as a guide when making decisions about prescribing opioids for patients with severe chronic pain.
There are many benefits to using PPLs to improve pain management, including reducing pain symptoms and helping people cope with chronic illness.”
The PALS Scale is available to view at: https://www.britishmedicines.gov.uk/sites/default/files/palliatives_act/publications/publication-detail-palliates_act-2018.pdf