NICE updates guidance on chronic pain treatments

The UK’s National Institute for Health and Care Excellence (NICE) has published draft guidance which details how some commonly used drug treatments for chronic primary pain have little to no effect.

The draft guidance says that patients with chronic primary pain should instead be offered other services, including supervised group exercise programmes, some types of psychological therapy or acupuncture.

Chronic primary pain is a condition in itself and can’t be attributed to the existence of another diagnosis, and is not the symptom of an underlying condition.

It is characterised by emotional distress and functional disability, and includes chronic widespread pain, chronic musculoskeletal pain and chronic pelvic pains.

The guidance also recommends the possible use of certain antidepressants for the treatment of people with chronic primary pain.

NICE also updated its guidance on prescribing paracetamol, non-steroidal anti-inflammatory drugs (such as aspirin and ibuprofen) benzodiazepines or opioids, and has recommended that these drugs should not be offered to people with chronic primary pain.

NICE maintains that there is not only little to no evidence that these drugs improve the quality of life for patients, but highlighted evidence that they can cause harm, including possible addiction.

The updated guidance also notes that antiepileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary 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,” said Paul Chrisp, director of the Centre for Guidelines at NICE.

“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,” he added.