Prescribe exercise instead of pills for chronic pain, says NICE 

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People with chronic primary pain should be offered a range of treatments to help manage their condition, says new guidance from NICE, rather than being started on drugs such as benzodiazepines or opioids. 

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A new Office for Health Promotion will help to ‘design and operationalise a step change in public health policy’

Chronic primary pain is defined as pain lasting more than three months and where the cause is unclear – pain caused by an underlying condition such as arthritis or ulcerative colitis is known as chronic secondary pain. The guideline emphasises the importance of shared decision making and ‘putting patients at the centre of their care’. Treatments known to be effective in managing chronic primary pain include exercise, cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). 

People who have been prescribed drugs for chronic primary pain are not being asked ‘to simply stop taking their medicines’ without being provided safer alternative options, stresses NICE.  Anyone prescribed drugs not recommended in the guideline should ask their doctor to review the prescription ‘as part of shared decision making’, it says, with options including continuing to take the medicines at a safe dose, or reducing and stopping with any issues around withdrawal ‘discussed and properly addressed’. NICE will publish guidelines on safe prescribing and withdrawal management of medicines associated with dependence later this year, it says. 

‘People with chronic primary pain should not be started on commonly used drugs including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids,’ said director of NICE’s Centre for Guidelines, Dr Paul Chrisp. ‘This is because there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress, but they can cause harm, including possible addiction. This guideline is very clear in highlighting that, based on the evidence, for most people it’s unlikely 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.’

Meanwhile, a new Office for Health Promotion will help to ‘design and operationalise a step change in public health policy’, the government has announced, including tackling issues such as alcohol use, smoking and mental health. The office, which will encompass most of the functions of Public Health England and launch in the autumn, will sit within the Department of Health and Social Care (DHSC) and recruit an expert lead who will report to the health secretary and chief medical officer. ‘It will enable more joined-up, sustained action between national and local government, the NHS and cross-government, where much of the wider determinants of health sit,’ the government says, with more details to be released later.  

Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain at www.nice.org.uk