Chronic pain patients should not use analgesics to alleviate their symptoms, an official health agency said.
The National Institute for Excellence in Health and Care (Nice), which provides guidelines for the NHS, has emphasized that commonly prescribed pain relievers such as acetaminophen, aspirin and opioids “have little or no evidence that they work”.
The treatments could even “do more harm than good” if a patient develops an addiction, he warned.
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Almost six million people in England and Wales were prescribed opioids in 2019, twice as many as 20 years ago. While the situation in the UK is far less serious than the addiction epidemic in the US, deaths from overdose are increasing.
Nice urge patients should be prescribed exercise, psychological therapy, or acupuncture instead.
“Little to no evidence” common pain relievers relieve discomfort
Chronic pain, whether recurring headache or back pain, affected between 13% and 50% of the British in 2019.
While pain is a spectrum, 10.4% to 14.3% suffered moderately or severely.
The NHS recommends a combination of exercise, physiotherapy, and pain relievers to help alleviate the debilitating symptom.
Over-the-counter analgesics include paracetamol or the anti-inflammatory drug ibuprofen.
In more severe cases, amitriptyline or gabapentin can be prescribed for pain caused by nerve sensitivity or damage such as shingles or sciatica.
The most powerful pain relievers available are morphine or medications like opioids.
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In his new report Chronic pain: assessment and treatmentNice warns, “a number of commonly used chronic primary pain drug treatments have little or no evidence that they work and should not be prescribed.”
Chronic primary pain is a condition in itself rather than a symptom of another diagnosis.
The report says that antidepressants can relieve symptoms in some cases.
It adds acetaminophen, but nonsteroidal anti-inflammatory drugs – such as aspirin and ibuprofen, benzodiazepines – “benzos”, and opioids should not be offered.
“This is because while there was little or no evidence that they changed people’s quality of life, pain, or mental distress, there was evidence that they could do harm, including possible addiction,” wrote the Team behind the report.
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Opioids are most commonly associated with addiction, with many offenders suffering from euphoria, followed by withdrawal symptoms.
Abuse can lead to life-threatening respiratory depression if the lungs do not exchange carbon dioxide and oxygen efficiently.
An increasing number of deaths in the UK mention an opioid pain reliever on the death certificate. The drug Tramadol is specifically responsible for around 240 deaths per year.
In the U.S., more than 67,000 people died from a drug overdose in 2018, nearly 70% of whom were on prescription or illegal opioids.
Unlike the U.S., the publicly funded UK health system means patients can’t go doctor-to-doctor to seek treatment, experts said at a Science Media Center briefing in January.
The British also had access to opioid substitution treatment, they added.
Patients Prescribed “Ineffective But Harmful Drugs”
Aside from opioids, nice stressed chronic pain patients should not be offered local anesthetics, ketamines, corticosteroids, or antipsychotics.
“This was also because there was little or no evidence that these treatments worked but could potentially do harm,” the team wrote.
They recommend acupuncture to some patients “provided that it is administered within certain, clearly defined parameters”.
The insertion of needles into problem areas is said to stimulate the sensory nerves under the skin and in the muscles and to trigger the release of pain-relieving endorphins.
Nice recommends acupuncture for chronic headaches or tension-type migraines. There is also evidence that it can relieve joint, tooth, or postoperative pain.
Acupuncture is sometimes available on the NHS, but most are private.
The Nice report, which is at the draft stage, also emphasizes that patients should be at the center of their care, promoting a supportive relationship between the individual and healthcare professionals.
“What this draft directive highlights is the fundamental importance of good communication for the experience of caring for people with chronic pain,” said Paul Chrisp of Nice.
“When many treatments are ineffective or not well tolerated, it is important to understand how pain affects a person’s life and those around them, because knowing what is important to the person is the first step in developing an effective one Care plan is.
“It is important that the draft directive also recognizes the need for further research into the range of possible treatment options, reflecting both the lack of evidence in this area and the need to offer more choices to people with the condition.”
Dr. Nick Kosky, a counseling psychiatrist at Dorset HealthCare’s NHS University Foundation Trust and chairman of the Nice Guidelines Committee, added that a “mismatch between patient expectations and treatment outcomes” can affect the relationship between a healthcare professional and the patient.
As a “consequence”, patients can be prescribed “ineffective but harmful medication”.
“This guideline, through a clearer understanding of the evidence for the effectiveness of chronic pain management, will help to increase the confidence of healthcare professionals in their discussions with patients. This way, they can better meet both their own and their patients’ expectations, ”added Dr. Kosky added.