Painkillers for chronic pain with no known cause should not be prescribed - according to health officials

People who suffer from chronic pain which has no known cause should not be prescribed painkillers, according to health officials.

The National Institute for Health and Care Excellence (NICE) has said that those suffering from chronic primary pain - which is pain that lasts more than three months - should be offered a variety of therapies instead of analgesics.

Therapies can include psychological therapies, exercise programmes, acupuncture and antidepressants.

New guidance highlights treatments including exercise programmes, psychological therapies and acupuncture

NICE said that there is “little or no evidence” that treating chronic primary pain - which is where the cause of the pain is unclear - with commonly used painkillers makes a difference to the quality of a person’s life, including their pain or psychological distress.

Instead, NICE suggests that people with chronic primary pain should be offered a variety of treatments through a care and support plan. This plan should be created jointly by a medic and the patient.

New NICE guidance highlights effective treatments including exercise programmes, psychological therapies, and acupuncture, but says “provided it is delivered within certain clearly defined parameters.”

Although NICE said that antidepressants can also be considered in the treatment plan, it said those with chronic primary pain should not be started on commonly used drugs. This includes paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids.

The guidance said that because there is little or no evidence that they make any difference to a person’s quality of life, they can actually cause harm instead, including possible addiction.

‘People shouldn’t be worried that we’re asking them to simply stop taking their medicines’

Dr Paul Chrisp, director of the Centre for Guidelines at Nice, said that the new guidance highlights that, based on the evidence, it’s unlikely for most people “that any drug treatments for chronic primary pain, other than antidepressants, provide an adequate balance between any benefits they might provide and the risks associated with them.”

However, Dr Chrisp added that “people shouldn’t be worried that we’re asking them to simply stop taking their medicines without providing them with alternative, safer and more effective options.”

He said that those who are currently taking medicines to treat their chronic primary pain which aren’t recommended in the NICE guideline “should ask their doctor to review their prescribing as part of shared decision making.”

“This could involve agreeing a plan to carry on taking their medicines if they provide benefit at a safe dose and few harms, or support for them to reduce and stop the medicine if possible,” Dr Chrisp added.

“When making shared decisions about whether to stop it’s important that any problems associated with withdrawal are discussed and properly addressed.”

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