The National Institute for Health and Care Excellence (NICE) has published its draft clinical guidelines, suggesting commonly used drugs including ibuprofen and paracetamol in the treatment of primary chronic pain, do more harm than good
Released yesterday and now available until 14 September 2020 for public consultation, NICE suggests that over the counter and GP prescribed medication for the management of chronic pain in over 16s could possibly cause addiction.
Primary chronic pain means long-term chronic pain that a healthcare professional cannot determine a diagnosis for, or is not due to another underlying condition. The medications currently in question to treat this pain include paracetamol, non-steroidal anti-inflammatory drugs (aspirin and ibuprofen), benzodiazepines or opioids, and some antiepileptic drugs such gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics.
“GPs need to be supported and resourced well enough so that they can spend a longer amount of time with their patients in order to provide a more holistic, safer treatment plan for chronic pain.”
In reference to the above drugs in the treatment of chronic pain, NICE found that 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.”
Instead, holistic therapies including acupuncture, psychological therapies such as cognitive behavioural therapy (CBT), supervised group exercise programs and some antidepressant medication were recommended as treatment.
Eytan Alexander, Managing Director of the drug addiction firm UKAT welcomed the latest guidelines, as in the last 18 months, prescription drug addiction treatment admissions have risen by 40%.
He says, “Prescription drug addiction is as real as a heroin addiction, but in this case, the addict gets their drugs from their GP rather than a dealer, to ‘treat’ their pain. We’re pleased to hear that today, the advice is that this should no longer be an option. GPs need to be supported and resourced well enough so that they can spend a longer amount of time with their patients in order to provide a more holistic, safer treatment plan for chronic pain. One that doesn’t lead to addiction.”
Chronic pain can be "characterised by significant emotional distress and functional disability" and will usually last longer than three months - often a lifetime - to be considered chronic. Emotional distress and mental health conditions such as anxiety and depression can be associated with chronic pain, an example of which is the condition Fibromyalgia (musculoskeletal pain), widespread pain throughout the body.
NICE reports that it’s estimated between a third and one half of the population are affected by chronic pain and “almost half of people with chronic pain have a diagnosis of depression and two-thirds of people are unable to work because of it.”
Emphasising the absolute importance of putting the patient at the centre of their care, the draft guideline suggests that good communication between patient and healthcare professional is key, and encouraging a collaborative, supportive relationship between the two is essential for people living with chronic pain.
Director of the Centre for Guidelines at NICE, Paul Chrisp said that working with a patient to understand how their life is impacted by chronic pain, is essential for treatment. “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.”
If you’re currently struggling with chronic pain, your GP should be your first port of call but there are lots of additional resources that can support you and your diagnosis.
To find out more information about acupuncture, what it is and how it can help, visit the Therapy Directory and find a practitioner in your local area.
For more information on addiction and psychological therapies such as CBT, or to find a counsellor who can support your emotional wellbeing, you can visit Counselling Directory or use the search bar below.