Pain treatments ‘can do more harm than good’: NICE
AS THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE PUBLISHES NEW GUIDANCE ON THE MANAGEMENT OF CHRONIC PAIN, SP ASKS WHETHER THE ADVICE CAN REALLY BE EFFECTED…
A
number of commonly-used drug treatments for chronic primary pain have little or no
evidence that they work and shouldn’t be prescribed, National Institute for Health and Care Excellence has said in its recent draft clinical guideline, which was published on the assessment and management of chronic pain in people over sixteen years of age.
Instead, the draft guideline, which is open to public consultation until 14 September 2020, says that people with a type of chronic pain called chronic primary pain should be offered supervised group exercise programmes, some types of psychological therapy, or acupuncture.
Definition of chronic pain Chronic pain - the name given to persistent, long-term pain which lasts more than twelve weeks – is estimated to affect one in five people
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in Scotland. In addition to the pain itself, chronic pain can also affect people living with long-term conditions such as diabetes, arthritis and back pain. At present, there are no official figures for the number of people adversely affected by opioid medication for chronic pain.
NICE’s draft guideline now recommends that some antidepressants can be considered for people with chronic primary pain. It says, however, that paracetamol, non-steroidal anti-inflammatory drugs (these include aspirin and ibuprofen), benzodiazepines or opioids should not be offered. This is because, while there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress, there was evidence that they can cause harm, including possible addiction.
The draft guideline also says that antiepileptic drugs including
gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary pain. Again, this was because there was little or no evidence that these treatments work but could have possible harms.
Acupuncture is recommended as an option for some people with chronic primary pain, provided it is delivered within certain, clearly defined parameters.
‘What this draft guideline highlights,’ said Paul Chrisp, director of the Centre for Guidelines at NICE, ‘is the fundamental importance of good communication to the experience of care for people with chronic pain. When many treatments are ineffective or not well tolerated it is important to get an understanding of how pain is affecting a person’s life and those around them because knowing what is important to the
person is the first step in developing an effective care plan.
‘Importantly the draft guideline also acknowledges the need for further research across the range of possible treatment options, reflecting both the lack of evidence in this area and the need to provide further choice for people with the condition.’
NICE’s guideline comes less than a year after the updated guideline that was produced by SIGN, part of Healthcare Improvement Scotland, which recommended safeguards to help protect patients from opioid addiction or overdose.
The updated Scottish guideline for the management of chronic pain recommended that people, who require opioids for pain relief – for example, codeine, morphine and tramadol – should receive early reviews of any newly-prescribed medication, and ongoing reviews at
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