New NICE guidance for chronic primary pain highlights the importance of individualised treatment

People with chronic primary pain should be offered a variety of treatments to help manage their condition and not automatically be started on commonly used drug treatments for pain, according to new National Institute for Health and Care Excellence (NICE) guidance on the assessment and management of chronic pain. 

Collaborative care

In the UK, the prevalence of chronic pain – defined as pain that lasts for more than three months – is uncertain, but could affect between one-third and one-half of the population.

The new guidance, published on 7 April 2021, emphasises the importance of putting patients at the centre of their own care and the need for shared decision making. It highlights the responsibility of healthcare professionals to gain an understanding of how a person’s life affects their pain and vice versa, including work and leisure time, relationships and sleep. A care and support plan should be developed based on the effects of pain on the individual’s day-to-day activities, as well as their preferences, abilities and goals, the guideline explains. Being honest about the uncertainty of the prognosis is also important, it adds.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, commented: “Achieving an understanding of how pain is affecting a person’s life and those around them, and knowing what is important to the person, is the first step in developing an effective care and support plan that recognises and treats a person’s pain as valid and unique to them.”

Alternative action

The guideline makes recommendations for effective interventions for chronic primary pain including exercise programmes, cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) and acupuncture within certain clearly defined parameters. 

The use of, or reliance on, drug treatments such as paracetamol, NSAIDs, benzodiazepines or opioids, is discouraged due to a lack of evidence that they improve quality of life, pain or psychological distress, and the risk of causing harm, such as addiction. However, antidepressants may be considered for those aged over 18 years to help with quality of life, pain, sleep and psychological distress, even in the absence of a diagnosis of depression.

“This guideline will provide more consistency in treatment and support on the NHS for people experiencing chronic pain,” said Lucy Ryan, a patient representative on the guideline committee. “I am pleased that it has highlighted the potential risks of some of the drugs used to treat chronic primary pain as I feel people are sometimes not made aware of these.”