‘Significant concerns’ due to pain management guidelines

Health professionals have come across concerns with new clinical guidelines for the management of chronic primary and chronic secondary pain.

The National Institute of Excellence in Health and Care (NICE) guidelines for those 16 years of age and older state that people with chronic primary pain should not take commonly used medications, including paracetamol, nonsteroidal anti-inflammatory drugs, benzodiazepines, or opioids because of a lack of evidence to work.

The guidelines say healthcare professionals should warn patients that medications may not improve their quality of life and may be harmful and addictive.

Instead, they recommend assessing the patient ‘person-centered’ based on how pain affects an individual’s life, which should include a person’s preferences, abilities, and goals.

Patients should also be aware of uncertainties regarding any prognosis, the text states.

Appropriate treatment could include exercise programs, psychological therapies like CBT, and even acupuncture.

According to NICE, an antidepressant could be considered for people over the age of 18 to ease pain and improve quality of life and sleep, even if a diagnosis of depression does not exist.

‘Significant concerns’

However, the guidelines have raised “significant concerns” by the Faculty of Pain Medicine (FPM) and other bodies.

The FPM said there was a real risk that those classified as having chronic primary pain “would involve a large number of people with a different, finally identifiable cause of pain, to whom these guidelines should not apply.”

Furthermore, there was a risk “that patients diagnosed with chronic primary pain who later develop secondary pain will neither be recognized nor treated appropriately,” the text reads.

The FPM requested a further review of how pain is managed and how services can be improved.

He also warned of potential consequences for patients if doctors discontinue access to useful medications to relieve pain symptoms.

The Royal College of General Practitioners (RCGP) said it has been seeking new clinical guidelines for pain management for some time. However, any departure from a pharmacological approach to the treatment of chronic primary pain would be limited by an “uneven” approach to physical and psychological therapies.

Prof. Martin Marshall, chairman of the RCGP, said: “It is also crucial that the guidelines advise not to start drug therapy for patients with chronic primary pain, but not to stop taking the drug, especially if they report some benefits.

“Patients who are prescribed pain medication should not stop taking the medication prescribed to them. If they are concerned, they should discuss this with their doctor at the next medication review, where alternatives to their treatment plan can be discussed.”

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