Painkillers 'Should Not Be Prescribed' For Some Types Of Chronic Pain

Painkillers such as paracetamol, ibuprofen, aspirin and opioids can do “more harm than good”, health officials said.
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Painkillers such as paracetamol, ibuprofen, aspirin and opioids should not be prescribed to treat primary chronic pain, health officials have said.

Draft guidance from the National Institute for Health and Care Excellence (NICE) said there was “little or no evidence” the commonly used drugs for chronic pain made any difference to people’s quality of life, pain or psychological distress.

But the draft guidance, published on Monday, said there was evidence they can cause harm, including addiction.

Chairman of the guidance committee, Nick Kosky, said while patients expected a clear diagnosis and effective treatment, the complexity of the condition means GPs and specialists can find it very “challenging” to manage.

The consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust said: “This guideline, by fostering a clearer understanding of the evidence for the effectiveness of chronic pain treatments, will help to improve the confidence of healthcare professionals in their conversations with patients.”

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Chronic primary pain is a condition in itself which cannot be accounted for by another diagnosis or as a symptom of an underlying condition, NICE said.

It is characterised by significant emotional distress and functional disability with examples including chronic widespread pain and chronic musculoskeletal pain, it added.

NICE said an estimated third to half of the population may be affected by chronic pain, while almost half of people with the condition have a diagnosis of depression and two-thirds are unable to work because of it.

The draft guidance, which is open to public consultation until September 14, said that people with the condition should be offered supervised group exercise programmes, some types of psychological therapy, or acupuncture.

It also recommends that some antidepressants can be considered for people with chronic primary pain.

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But it said that paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, benzodiazepines or opioids should not be offered because there was “little or no evidence” that they helped.

The draft guideline also said antiepileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary pain because, again, there was little or no evidence that these treatments work but could have possible harms.

Paul Chrisp, director of the centre for guidelines at NICE, said: “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.”

  • Update: This article has been amended to make clear that the draft guidelines refer to primary chronic pain only.

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