NICE publishes new guidance on chronic pain management

The UK National Institute for Health and Care Excellence (NICE) has published new guidance on the assessment of chronic pain, recommending exercise instead of commonly used drugs such as paracetamol as part of its guidelines.

Chronic or persistent pain is characterised by pain that lasts for more than three months and is estimated to affect between 1-6% of people in England.

The guidance, published by NICE last week, has placed emphasis on shared decision making by recommending patients be put at the centre of their care.

NICE recommends that a care and support plan be developed for people suffering with chronic pain, which should be based on the effects of pain on day-to-day activities, as well as individual’s preferences, abilities and goals.

As part of the guidance, NICE has recommended treatments that have been shown to be effective in managing chronic pain, including exercise programmes, psychological therapies such as CBT and acceptance and commitment therapy (ACT) and acupuncture.

In addition, NICE recommends that people with chronic primary pain should not be started on commonly used drugs such as paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids.

According to NICE, there is little or no evidence that these drugs make a difference to the quality of life of people living with chronic pain, adding that they can cause harm and possible addiction.

Antidepressants can also be considered for people aged over 18 years old to manage chronic pain in the guidance, following a full discussion of the benefits and harms.

“This guideline is very clear in highlighting that, based on the evidence, for most people it’s unlikely that any drug treatments for chronic primary pain, other than antidepressants, provide an adequate balance between any benefits they might provide and the risks associated with them,” said Paul Crisp, director of the Centre for Guidelines at NICE.

In response to the new guidelines for chronic primary pain, Martin Marshall, chair of the Royal College of GPs commented: "We […] understand the move away from a pharmacological option to treating chronic primary pain to a focus on physical and psychological therapies that we know can benefit people in pain.”

“However, access to these therapies can be patchy at a community level across the country, so this needs to be addressed urgently, if these new guidelines are to make a genuine difference to the lives of our patients with primary chronic pain,” he added.