Helping to Optimise Pain control in the Elderly experiencing Analgesic Overprescribing (HOPE-AO)

Understanding and improving how chronic pain is managed in older adults
Female pharmacist dispensing medication in a pharmacy
Title: Helping to Optimise Pain control in the Elderly experiencing Analgesic Overprescribing (HOPE-AO)
Funded by: NIHR
Funding amount: £249,073
Location: Plymouth
Dates: 1 April 2025 – 29 September 2026
Project partners: University of Plymouth Faculty of Health, NIHR, University of Aberdeen, Aston University, University of Exeter, NELFT NHS Foundation Trust
University of Plymouth PI, Co-I: Professor Patricia Schofield , Dr Stuart Spicer
University of Plymouth staff: Professor Richard Byng
 

Summary

This project will investigate the prescribing of pain medicine in older adults, so that we can understand the issue more fully and work towards better and safer pain management practices.
Many older adults are prescribed multiple medications to manage their chronic pain. However, these treatments are often insufficiently monitored, with healthcare professionals continuing to add new drugs without discontinuing those that may no longer be effective. This can lead to older adults taking medications that are not only ineffective but may also cause unpleasant side effects, potentially resulting in health a crisis such as a fall or gastric bleeding.
During this project, we plan to explore prescribing patterns using the Clinical Practice Research Datalink (CPRD) database. We will also conduct qualitative interviews with older adults, their carers and healthcare professionals to understand their perspectives, and aim to develop or co-design alternative and safer approaches to prescribing.
The project involves experts from across the UK who will work together to achieve the objectives.

Objectives

  • Understand more about older adults (65+) who are taking pain medicines. This will help us to understand who we need to help.
  • Understand more about people's experiences of taking pain medicines, along with their broader experiences of managing pain. This will help us to understand how we can help people.
A senior lady and her daughter are linking arms about to cross a road. They have picked up a prescription from the pharmacy behind them.

Research plan

  • To understand who to help, we will analyse medical data from the CPRD, covering 18 million patients. We will investigate who is taking these medicines, for how long, and what health conditions they have. We will look for differences between groups of people, and we will look at which health services people use.
  • To understand how to help, we will interview 30 people who are taking these medicines, along with their family carers. We will also interview 10 healthcare professionals. This will help us to understand people's perception of how well these medicines work, how they feel about taking them, what else they do to manage their pain, and what they think about their wider healthcare.

Patients and public

We are working with a panel of public contributors throughout every stage of the project, overseen by a lived experience patient and public involvement lead. We have already worked with patients and members of the public in preparation for this project.
The panel will help to solve problems, share expertise, plan activities, co-develop research activities, and make sense of findings.

Outcomes

We will share our research outputs with professionals, researchers, patients, and members of the public. We will publish research papers and present findings at conferences and other events.
We will also prepare for a follow-on programme to design, roll out and evaluate a framework for better and safer pain management.
 
 

UoP team members

 
 

External team members

Victoria Abbott-Fleming MBE
Victoria Abbott-Fleming MBE is the Founder and Chair/CEO of Burning Nights CRPS Support, a national charity dedicated to supporting anyone who has been impacted by Complex Regional Pain Syndrome (CRPS). After her own life-changing experience with CRPS, which led to bilateral above-knee amputations, Victoria established the charity to raise awareness, provide crucial support services, and advocate for better patient care.
She is also the Chair of the Expert Patient and Carer Committee at the British Pain Society (BPS), ensuring that the voices of those with lived experience of pain, help shape the future of care and management of people affected by any form of pain.
Victoria is also actively involved in Patient and Public Involvement and Engagement (PPIE) as part of pain research, working as a PPIE Lead and contributing to a number of PPIE panels and committees. Through these roles, she collaborates with those with lived experience, healthcare professionals, researchers, and stakeholders to improve patient-centred approaches and enhance pain management strategies.
Victoria’s work is driven by a passion for ensuring that patients and carers' voices are heard, involved, and supported, particularly in areas where there are significant gaps in care and understanding.
  • Victoria Abbott-Fleming MBE

    Victoria Abbott-Fleming MBE

Dr Mark Horowitz
Dr Mark Horowitz is a Clinical Research Fellow in Psychiatry at North East London NHS Foundation Trust (NELFT) and a Visiting Lecturer in Psychopharmacology at King's College London. He authored the Royal College of Psychiatrists' guidelines on 'Stopping Antidepressants' and his research has informed the NICE guidelines on safely stopping psychiatric drugs. He runs a psychiatric drug deprescribing clinic at his Trust. His interest in stopping psychiatric medications arose from his own difficult experience doing so.
  • Dr Mark Horowitz

    Dr Mark Horowitz

Professor Ian Maidment
Professor Ian Maidment is an academic clinical pharmacist based at Aston University. Prior to moving to academia in 2012, he spent 20+ years working in the NHS mainly in mental health services, dementia/care of older people and community pharmacy. His research is focused on medication use in the real world particularly in vulnerable populations.
He has led seven grants funded by NIHR/UKRI e.g., NIHR-MEDIATE study on medication optimisation in severe mental illness plus co-applicant on numerous others and has published over 130 papers in peer reviewed journals.
  • Professor Ian Maidment

    Professor Ian Maidment

Professor Paul McNamee
Paul McNamee is Professor of Health Economics at the Health Economics Research Unit, University of Aberdeen. He has published widely on chronic pain, MSK and older people, and has conducted research on the application of discrete choice experiments (DCE) to inform healthcare delivery decisions. He will advise on the project as a whole and oversee the DCE research.

Professor Phyo Kyaw Myint
Professor Myint is an academic geriatrician with expertise in clinical epidemiology. He currently hold the position of Clinical Chair in Medicine of Old Age with the University of Aberdeen and he leads Ageing, Clinical & Experimental Research (ACER) Group, Institute of Applied Health Sciences. One of his clinical and research interests is medicines management in older people with a particular focus on medicine optimisation.
  • Professor Phyo Kyaw Myint

    Professor Myint

Professor Rupert Payne
Rupert Payne is a senior academic GP and Professor of Primary Care and Clinical Pharmacology at the University of Exeter. He has a longstanding interest in medicines optimisation and polypharmacy, with particular methodological expertise in the use of electronic health data. He co-authored a King's Fund report on polypharmacy which significantly influenced policy over the following decade, and chaired the Research and Evidence subgroup for the National Overprescribing Review. He co-chairs the UK's Society for Academic Primary Care.
  • Professor Rupert Payne

    Professor Rupert Payne

Dr Carrie Stewart
Dr Carrie Stewart is a research fellow at the University of Aberdeen. Her research experience since 2010 has been framed around improving the health and wellbeing of older people. This has involved conditions such as chronic pain and dementia, and potentially harmful medicines, most notably her work around anticholinergics. She is a mixed method researcher, who primarily focuses on the use of qualitative methods. She also has evidence synthesis, epidemiology and clinical trial management experiences. She is an advocate for patient and empowerment and PPI, and leads an ageing health focused PPI group in Aberdeen.
  • Dr Carrie Stewart

    Dr Carrie Stewart

 
 

Project partners