BIN THE PAINKILLERS SAYS NICE
National Institute for health and Care Excellence (NICE) has said that people with chronic primary pain should be offered a range of treatments to help them manage their condition.
N
ICE’s newly-issued guideline on the assessment and management of chronic pain is the follow-up to their draft
guidance, which was published last August, which first mooted the idea that commonly-used drug treatments for chronic primary pain have little or no evidence that they work and shouldn’t be prescribed.
The NICE guideline makes recommendations for treatments that have been shown to be effective in managing chronic primary pain. These include exercise programmes, the psychological therapies Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) and acupuncture.
What is chronic pain? Pain that lasts for more than three months is known as chronic or persistent pain. In the UK, the prevalence of chronic pain is uncertain, but appears common, affecting perhaps one third to one half of the population.
Chronic primary pain represents chronic pain as a condition in itself and which can’t be accounted
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for by another diagnosis, or where it is not the symptom of an underlying condition (this is known as chronic secondary pain). It is characterised by significant emotional distress and functional disability and examples include chronic widespread pain and chronic musculoskeletal pain, as well as conditions such as chronic pelvic pain.
Chronic pain that is caused by an underlying condition (for example, osteoarthritis, rheumatoid arthritis, ulcerative colitis, endometriosis) is known as chronic secondary pain. Where the cause of the pain is unclear, it is called chronic primary pain.
According to the NICE guideline, people with chronic primary pain should not be started on commonly-used drugs including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids. This is because there is little or no evidence that they make any difference to people’s quality of life, pain or
psychological distress, but they can cause harm, including possible addiction.
‘We want this guideline to make a positive difference to people with chronic pain, and their families and carers,’ said Dr Paul Chrisp, director of the Centre for Guidelines at NICE. ‘It highlights that achieving an understanding of how pain is affecting a person’s life and those around them and knowing what is important to the person is the first step in developing an effective care and support plan that recognises and treats a person’s pain as valid and unique to them.’
The guideline also recommends that an antidepressant can be considered for people aged 18 years and over to manage chronic primary pain, after a full discussion of the benefits and harms. This is because the evidence shows antidepressants may help with quality of life, pain, sleep and psychological distress, even in the absence of a diagnosis of depression.
WE WANT THIS GUIDELINE TO MAKE A POSITIVE DIFFERENCE TO PEOPLE WITH CHRONIC PAIN, AND THEIR FAMILIES AND CARERS: NICE
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