05 Apr No More Painkillers: In accordance with new NICE guidelines
Chronic pain is defined as pain lasting or recurring for more than three months. Chronic Primary Pain is where the cause of the pain is unknown, and Chronic Secondary Pain is when the pain is caused by an underlying condition. It is believed that approximately twenty million people suffer with chronic pain in Britain (Gibbons, 2021).
New guidelines by the National Institute for Health and Care Excellence (NICE) have instructed doctors not to administer painkillers for people with chronic pain (Gibbons, 2021). NICE has stated that there was not enough substantial evidence to prove that painkillers, opioids, non-steroidal anti-inflammatory drugs, or benzodiazepines made a difference to the quality of life, pain or psychological distress of a person experiencing chronic pain.
NICE has recommended that anti-depressants be used instead of painkillers. Unlike painkillers that could cause harm and potential addiction, the anti-depressants help with the quality of life, pain, sleep, and psychological distress even if though the patient is not diagnosed with depression. Patients considering the use of anti-depressants need to be informed about the side effects. NICE suggests that people suffering from chronic pain should also be offered a variety of therapies, including exercise programs, psychological treatment, and acupuncture (Gibbons, 2021).
The director of the Centre for guidelines at NICE, Dr P. Chrisp said “For most people it’s unlikely that any drug treatments for chronic primary pain, other than taking antidepressants, would provide an adequate balance between any benefits they might provide, and the risks associated with them. But people should not be worried that, we are asking them to simply stop taking their medicines without providing them with alternative, safer, and more effective options. When making shared decisions about whether to stop, it’s important that any problems associated with withdrawal are discussed and properly addressed.”
Professor M. Marshall, the chairmen at the Royal College of GPs, welcomes the move away from pharmacological options to a focus on physical and psychological therapies (Gibbons, 2021), said “Pain can cause untold misery for patients and their families. As GPs, we want to be able to help patients manage their pain and live as normal a life as possible, but chronic primary pain can be challenging to manage”. He also added did add that, “access to these therapies can be patchy at a community level across the country, so this needs to be addressed urgently if these new guidelines are to make a genuine difference to the lives of our patients with primary chronic pain”.
However, Dr R Muglani, a consultant in pain medicine at the Royal Papworth Hospital in Cambridge said that the NICE guidance was detached from the daily treatment of patients with chronic pain. Stating that “Some patients, but not all, will respond to drugs such as opioids, but most treatments have essentially been thrown out of the guidance. If somebody comes in with severe chronic pain, are we seriously not going to consider a trial of an opioid to see if it is helpful to them? Are we simply going to give them an antidepressant or suggest psychological therapy instead? These guidelines are very much divorced from the reality of dealing day-to-day with chronic pain patients”.
Many patients will be reluctant to take antidepressants because of the stigma related to it. Users of antidepressants are often perceived to be emotionally unstable, severally ill or lack the ability to deal with problems. Many people may also believe that the use of antidepressants will be ineffective.
Possible side effects of opioids and antidepressants are drowsiness, slowed breathing, unconsciousness, nausea, feeling agitated, low sex drive, seizures, reduced appetite, constipation, insomnia, diarrhoea, weight gain, excessive sweating, and heart palpitations. Continual excessive use of the medication can result in physical dependence and addiction. These side effects can affect a patient’s quality of life and therefore assessed for long term use.
Here at OsteoVision we offer physical therapy for musculoskeletal conditions which supplement a patient’s recovery in conjunction with their prescribed medication, to help ease both acute and chronic pain. A member of our specialist team will create a treatment plan according to your specific needs. Contact us today to book an assessment.