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NICE guidance on chronic pain could prevent patients receiving life altering treatments

Nice guidance on chronic pain creates wrong messages and potentially stops patients receiving life altering medication.


This week NICE (the UK’s National Institute for Health and Care Excellence) published it’s long awaited guidance on chronic pain. Unfortunately, this has created more confusion than clarity and potentially prevents patients receiving life altering medication.


The Nice article presents the following bold headline:

Commonly used treatments for chronic pain can do more harm than good and should not be used, says NICE in draft guidance
A number of commonly used drug treatments for chronic primary pain have little or no evidence that they work and shouldn’t be prescribed, NICE has said in its draft clinical guideline published today (3 August 2020) on the assessment and management of chronic pain in over 16s.

https://www.nice.org.uk/news/article/commonly-used-treatments-for-chronic-pain-can-do-more-harm-than-good-and-should-not-be-used-says-nice-in-draft-guidance


Three Key problems created by the guidance:


1. The guidance comes across as if it is for all chronic pain – but it is for a sub-set termed ‘Primary Chronic Pain’.


2. There is no clear definition given within the guidance of who is affected by ‘Primary Chronic Pain’ even though a clear definition is given by the IASP. This is a relatively new term which needs to be explained - even experts in the field are not clear on this. (https://journals.lww.com/pain/Fulltext/2019/01000/The_IASP_classification_of_chronic_pain_for.4.aspx)


3. Patients may be denied treatment that can be life altering for them:


  • There are 6 other categories of chronic pain to which commonly used treatments can have benefit or are even proposed as first line treatment by the NHS.

  • Even within ‘Primary Chronic Pain’ there are groups of patients to which commonly used treatments are recommended by the NHS e.g.

  • Fibromyalgia – NHS recommendations include paracetamol and Gabapentin/Pregabalin

  • Migraine – NHS recommendations include paracetamol, aspirin and ibuprofen.


NICE needs to act!!


NICE needs to create much more clarity that these new recommendations are effectively for a small proportion of chronic pain patients AND understand that there are current guidelines recommending the treatments they are suggesting to ban across the other pain categories and even within the Chronic Primary Pain category.

Background on main categories of pain and the pain conditions associated with Chronic Primary Pain:


Chronic Primary Pain is just one of seven main categories of pain


The seven main categories of chronic pain:

  1. Chronic primary pain

  2. Chronic cancer-related pain

  3. Chronic postsurgical and chronic post-traumatic pain

  4. Chronic neuropathic pain

  5. Chronic secondary headache or orofacial pain

  6. Chronic secondary visceral pain

  7. Chronic secondary musculoskeletal pain

(see: https://cdn-links.lww.com/permalink/pain/a/pain_2019_01_03_treede_pain-d-all-icd-11_sdc1.pdf)

Conditions associated with Chronic Primary Pain


(see https://cdn-links.lww.com/permalink/pain/a/pain_2019_01_03_treede_pain-d-all-icd-11_sdc1.pdf)


Further reading on classification of chronic pain.


Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)

https://journals.lww.com/pain/pages/articleviewer.aspx?year=2019&issue=01000&article=00003&type=Fulltext


The IASP classification of chronic pain for ICD-11: chronic primary pain.

https://journals.lww.com/pain/Fulltext/2019/01000/The_IASP_classification_of_chronic_pain_for.4.aspx

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