NICE Guidance on Pain Medications
New guidance from NICE recommends against several commonly used drugs as the first line of treatment for chronic primary pain. NICE calls out non-steroidal anti-inflammatories, benzodiazepines, opioids – and even paracetamol.
What’s left? Far fewer options for treating chronic pain, it would seem. NICE exempted only anti-depressants to help patients deal with their pain.
NICE claims that there is little or no evidence that the medications named make a difference to people’s quality of life, pain or psychological distress. They also point out that the medications can cause harm, including addiction.
Impact on Patients
The impact will be widely felt.
Chronic Pain Policy Coalition Chair Neil Betteridge cited growing concerns from health care professionals that this guidance could “lead to busy clinicians withdrawing existing medication in an overzealous fashion.”
NICE earlier told stakeholders that “the guideline should not be interpreted to mean all medicines should be withdrawn,” Betteridge explained, adding, “But this welcome caveat did not appear in the final guidance.”
Many remain concerned that blanket and inexpert withdrawal of medication in such a vulnerable group of patients could lead to despair and unintended harm. The UK patient group Pain Concern reported that, based on calls and emails to their helpline, “these new guidelines are causing distress and anxiety to people living with chronic pain.”
“Whilst we welcome the guidance,” a recent press release from Pain Concern noted, “we need every tool available in our toolbox to help in [pain] management. Now is not the time to reduce our options”.
Once again there is widespread concern that patient-centred care, where individual patients and clinicians work out between them what is best in each unique case, has been jeopardised by the imposition of a one size-fits-all approach.
Pain in England
In the UK, chronic pain affects one-third to one-half of the population. Chronic, or persistent, pain is defined as pain lasting at least three months. The prevalence of chronic primary pain is unknown but is estimated by the British Pain Society to be between 1% and 6% in England.