The National Institute for Health and Care Excellence (NICE) has come out with a draft guideline on drug treatments for relieving chronic primary pain. It says that there is ‘little or no evidence’ of their positive effect on the management of pain, and it should not be prescribed.
For relieving acute pain, over the counter (OTC) painkillers are easily available from the pharmacies. Medications like Tylenol, ibuprofen, acetaminophen (paracetamol) and aspirin, do not require any prescription to treat a frustrating pain that doesn’t usually leave the body until it is taken.
However, NICE stated that chronic primary pain, characterized by emotional distress and functional disability, should be treated with group exercise programs, psychological therapies, and/or acupuncture, rather than relying solely on drugs.
People with chronic widespread pain which include musculoskeletal pain, and also conditions of chronic pelvic pain need to be put under the care of a collaborative and supportive relationship between the patients and the healthcare professional, the report says.
Paul Crisp, Director at NICE, emphasized the fundamental importance of care with good communication with the patients undergoing such pain as an effective management solution.
The draft guidelines recommend acupuncture as a better option than antidepressants and antiepileptic drugs for the management of primary chronic pain. But acupuncture treatment should be done with well-defined parameters. it must be noted.
Antidepressants can be considered to relieve primary chronic pain, but it says paracetamol, non-steroidal anti-inflammatory drugs (aspirin and ibuprofen), benzodiazepines, or opioids should not be offered.
It must be noted there’s a difference between chronic pain and chronic primary pain. the latter refers to chronic pain as an ailment in itself, no withstanding another disease or a side-effect. Chronic pain as a result of trauma or other physical condition is called secondary chronic pain.
Little to no evidence
“[…] 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,” the NICE report says.
Similarly, antiepileptic drugs such as gabapentinoids, local anaesthetics, ketamine, corticosteroids, and antipsychotics should not be prescribed to patients to manage chronic primary pain.
Both antidepressants and antiepileptic drugs have little or no evidence of creating an impact as far as the quality of life, pain, and psychological distress are concerned. Rather, it causes more harm, and sometimes there is a possibility of addiction, the researchers noted.
Usually, an initial injury, such as a back sprain or pulled muscle can become the cause of chronic pain. The nerves get damaged and so the pain gets intense and long-lasting. In these cases, treating the underlying injury may not resolve chronic pain.
Healthline reports that other than external injury, some of the following conditions are also the cause of chronic pain:
- Chronic fatigue syndrome (extreme, prolonged weariness accompanied by pain)
- Endometriosis (growth of the uterine lining outside the uterus causes pain)
- Fibromyalgia (a pervasive pain in the bones and muscles)
- Inflammatory bowel disorder (conditions which develop into inflammation in the digestive tract causing pain)
- Interstitial cystitis (characterized by bladder pressure and pain)
- Temporomandibular joint dysfunction (TMJ) ( symptoms of painful clicking, popping, or locking of the jaw)
- Vulvodynia (vulva pain which becomes chronic without any specific cause)
If chronic pain is not treated to the satisfaction of the person, it creates a substantial impact on the concerned person and his families. Many cases show that developing psychological depression is a natural consequence of the same.
Why chronic pain treatment is largely unsated?
The concern over ineffective or not well-tolerated treatments has pushed the draft guidelines to lay importance on getting to understand how pain is affecting the patient’s life and those around him.
For developing an effective care plan the first step is to know what is important and what is affecting the person to cause such pain, director of the Centre for Guidelines at NICE, Paul Chrisp said.
It has been observed that GPs and specialists often face challenges while managing treatment for chronic pain. The expectations of the patients and the outcome of treatments are sometimes frustrating.
The reason behind is due to the prescribed ineffective and harmful drugs, which in turn affects the relationship between the healthcare expertise and the patient.
The consultant psychiatrist and chairperson of the guideline committee, Nick Kosky 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. In doing so it will help them better manage both their own and their patient’s expectations.”
After an amendment, the article states that the drafted guidelines will be kept open to public opinion and consultation until 14 September 2020.