Pharmacy’s leading expert in pain management almost missed his calling twice — Roger Knaggs originally intended to work in the pharmaceutical industry and then completed most of the required training to become a doctor before finally finding himself in hospital pharmacy.
“As an undergraduate, I was always interested in research but found the patient contact more enjoyable and fulfilling than I thought,” he says, “but I already had plans to do a PhD so went to do that.” Knaggs’ PhD, which was based on opioids and pharmacokinetics, sparked an unexpected interest for him that ultimately marked the beginning of his career.
“It was just by chance through discussion with some potential supervisors that the topic for my PhD came about. I didn’t know that several years later I’d be walking into a job that specialised in pain and anaesthetics. Looking back, that’s probably where it all started — having three years to spend a lot of time getting to know analgesics in a lot of detail,” he remembers.
Accolades and alterations
Knaggs recently became the first non-medical healthcare professional to receive the Fellowship by Election of the Faculty of Pain Medicine of the Royal College of Anaesthetists; a lifetime accolade. However, initially, Knaggs believed the only way he could fulfil his career ambitions was to become a doctor.
“While I was finishing my PhD, I had this idea about wanting to be able to mix both academia, particularly research, and clinical practice,” he explains. “But in the late 1990s there weren’t many clinical academic posts. The only way that I could see it was going to work was to do medicine.”
Knaggs’ plans were somewhat scuppered when he had to take time out in his final year and was unable to return to complete his degree. Fortunately, he had continued working as a locum pharmacist in the hospital pharmacy at Queen’s Medical Centre in Nottingham (now part of Nottingham University Hospitals NHS Trust with Nottingham City Hospital and Ropewalk House).
“I am happy with the way in which things have worked out,” reflects Knaggs. “The role of the doctor from the mid-1990s to the mid-2000s changed a great deal.” He adds that many of the opportunities he had as a pharmacist would not have been available to him as a doctor until much later in his career.
In the early 2000s, Knaggs began work providing a clinical pharmacy service to the Anaesthetics Directorate and Pain Management Service, a role he held for more than ten years. “In the early 2000s it was unusual for there to be a pharmacist working so closely with theatres and anaesthetics,” Knaggs remembers. “But, as a large teaching hospital with around 20 theatres, there was a wish from the anaesthetics directorate for more support in relation to drugs.”
A blossoming reputation
In 2005, Knaggs began to develop a reputation locally, which blossomed after he won the UK Clinical Pharmacy Association (UKCPA) Napp pain award for his project ‘Prescribing and clinical outcomes after strong opioid recommendation for a chronic non-cancer pain from a pain clinic’. Knaggs saw this achievement as an opportunity to drive the development of an interest group looking specifically at pain.
The UKCPA Pain Management Group was consequently established in 2006, of which Knaggs was chair. “It’s an online network for people to discuss burning clinical issues or issues about how to manage particular types of pain or particularly problematic patients,” he explains. “It also provides support and arranges educational events, often in association with some of the other UKCPA groups, such as the surgical and theatres group.” In 2015, Knaggs handed over the reigns as chair but he is still involved with the group.
In 2007, Knaggs was invited to be co-opted to the British Pain Society Council, a multi-professional organisation of people working in the field of pain, as the only pharmacy representative. Between 2011 and 2013, he was an elected council member and now he holds the position of honorary secretary where he has more involvement in the day-to-day running and organisation of the society.
Investigations and conversations
In addition to upholding his honorary positions, Knaggs currently splits his time between his role as an associate professor in clinical pharmacy practice and an advanced pharmacy practitioner. “It’s nice to be able to mix and continue my clinical practice at the same time as teaching and trying to develop a research portfolio as well. The research informs my practice and practice informs my research.”
On the academic side, Knaggs’ research is currently focused on analysing trends in analgesic prescribing. In his clinical practice, Knaggs works exclusively with pain patients. “Clinically I tend to see a lot of patients who have ended up, for whatever reason, taking large doses of opioids.”
However, Knaggs stresses that medicines are just one part of working with patients with long-term pain. “You need to be able to have a conversation with a patient about their mood, their sleep and other issues that we might not delve into on a regular basis,” he says. “I see a lot of my role is about putting medicines into perspective. It’s about getting the patients to think about what impact that pain is having and taking time to work with them in terms of what they would actually want to achieve.”
Interestingly, despite being a specialist himself, Knaggs believes it is vital that healthcare professionals remain generalists when it comes to pain. “There is a very wide spectrum of pain ranging from the things that community pharmacists see on a day-to-day basis to the hospital environment, where you’ve got post-surgical pain,” he says. “It’s an area that all pharmacists need to have a good knowledge of. As a profession, we can support patients in a few ways.”