Paracetamol, ibuprofen shouldn’t be prescribed for chronic primary pain, say UK health officials

Common treatments including painkillers such as paracetamol, ibuprofen, aspirin and opioids should not be prescribed for chronic primary pain as they can do more harm than good, according to UK health officials.

UK’s National Institute for Health and Care Excellence (Nice) on Monday published draft clinical guidelines for the treatment of chronic primary pain that read, “A number of commonly used drug treatments for chronic primary pain have little or no evidence that they work and shouldn’t be prescribed.”

The guidelines describe chronic primary pain as a type of chronic pain which is a “condition in itself and which can’t be accounted for by another diagnosis, or where it is not the symptom of an underlying condition (this is known as chronic secondary pain). It is characterised by significant emotional distress and functional disability.”

According to NICE, paracetamol, non-steroidal anti-inflammatory drugs (these include aspirin and ibuprofen), benzodiazepines or opioids should not be prescribed to patients with the condition.

“This is because, while there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress, there was evidence that they can cause harm, including possible addiction,” it said.

It also said that antiepileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary pain due to similar reasons.

The condition can often take a toll on individuals and their families. Almost half of the people with chronic pain have a diagnosis of depression and two-thirds of such people are unable to work because of it, the health agency said.

People with chronic primary pain “should be offered supervised group exercise programmes, some types of psychological therapy, or acupuncture. The draft guideline recommends that some antidepressants can be considered for people with chronic primary pain,” it said.

Paul Chrisp, Director of the Centre for Guidelines at NICE, said: “It is important to get an understanding of how pain is affecting a person’s life and those around them because knowing what is important to the person is the first step in developing an effective care plan.

“Importantly, the draft guideline also acknowledges the need for further research across the range of possible treatment options, reflecting both the lack of evidence in this area and the need to provide further choice for people with the condition.”

Nick Kosky, consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust and chair of the guideline committee, said: “Understandably, people with chronic pain expect a clear diagnosis and effective treatment. But its complexity and the fact GPs and specialists alike find chronic pain very challenging to manage, means this is often not possible. This mismatch between patient expectations and treatment outcomes can affect the relationship between healthcare professionals and patients, a possible consequence of which is the prescribing of ineffective but harmful drugs.

“This guideline, by fostering a clearer understanding of the evidence for the effectiveness of chronic pain treatments, will help to improve the confidence of healthcare professionals in their conversations with patients. In doing so it will help them better manage both their own and their patient’s expectations.”

The draft guideline is now open to public consultation until September 14, 2020.

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