'Significant Concerns' Over Pain Management Guidance

Peter Russell

April 08, 2021

New clinical guidance for managing chronic primary pain and chronic secondary pain has been met with concern by health experts.

Guidelines from the National Institute for Health and Care Excellence (NICE) for those aged 16 and older state that people with chronic primary pain should not be started on commonly used drugs including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines, or opioids because of a lack of evidence that they work.

The guidance said that health professionals should warn patients that drugs may not improve quality of life and could cause harm and be addictive.

Instead, they recommend a 'person-centred' assessment of patients based on how pain affects the life of an individual, which should include a person's preferences, abilities, and goals.

Patients should also be made aware of uncertainties about any prognosis, it said.

Appropriate treatment could include exercise programmes, psychological therapies such as CBT, and even acupuncture.

An antidepressant could be considered for people over 18 to help ease pain and improve quality of life and sleep, even in the absence of a diagnosis of depression, according to NICE.

'Significant Concerns'

However, the guidelines have aroused "significant concerns" from the Faculty of Pain Medicine (FPM) and other bodies.

The FPM said there was a real risk that those classed as having chronic primary pain would "include large numbers of people with a different, ultimately identifiable cause of pain, to whom this guidance should not apply".

Furthermore, there was also a risk "that patients who are diagnosed with chronic primary pain, and who subsequently develop secondary pain, are neither recognised nor treated appropriately", it said.

The FPM called for a further review of how pain is managed and how services could be improved.

It also warned of the potential consequences for patients if doctors discontinued access to useful medications to alleviate pain symptoms.

The Royal College of GPs (RCGP) said it had been calling for new clinical guidelines on pain management for some time. However, any move away from a pharmacological-based approach to treating chronic primary pain would be limited by "patchy" access to physical and psychological therapies.

Prof Martin Marshall, chair of the RCGP, said: "It's also key that the guidelines advise against starting drug-therapy for patients who have chronic primary pain, but not to stop medication already being taken, particularly if they report some benefit.

"Patients who have been prescribed medication for their pain should not stop taking medication that has been prescribed to them. If they are concerned, they should discuss this with their doctor at their next medication review, where alternatives to their treatment plan can be discussed."


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