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NICE recommends CBT, acupuncture, and anti-depressants for chronic pain

Published on 07/04/21 at 09:28am

A new NICE guideline on the assessment and management of chronic primary pain does not recommend the prescription of painkillers, including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines, or opioids.

The assessment states this is due to there being “little or no evidence” that they make any difference to people’s quality of life, pain or psychological distress and can have a harmful impact on a patient’s life, including possible addiction.

Chronic primary pain means that no underlying condition adequately accounts for the pain or its impact. In these cases, NICE now recommends a range of treatment options depending on the specific patient’s needs, including exercise programmes, psychological therapies CBT and acceptance and commitment therapy (ACT), and acupuncture.

In the report, NICE also stated that for people aged 18 and over antidepressants amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline can be considered.

Dr Paul Chrisp, Director of the Centre for Guidelines at NICE, said: “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.

“But people shouldn’t be worried that we’re asking them to simply stop taking their medicines without providing them with alternative, safer and more effective options. First and foremost, people who are taking medicines to treat their chronic primary pain which aren’t recommended in the guideline should ask their doctor to review their prescribing as part of shared decision making.”

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 it appears to be common, affecting around one-third to one-half of the population. The prevalence of chronic primary pain is unknown but is estimated to be between 1% and 6% in England.

Nick Kosky, a consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust and chair of the guideline committee, said: “Understandably, people with chronic pain expect a clear diagnosis and effective treatment. But its complexity and the fact GPs and specialists alike find chronic pain very challenging to manage, means this is often not possible.

“This guideline underlines the importance of appropriate assessment, careful drug choice, exercise programmes, psychological therapies, and consideration of acupuncture in improving the experience and outcomes of care for people with chronic pain.”

Kat Jenkins


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