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Nice: Don't prescribe opioids and paracetamol for chronic primary pain

Nice said certain drugs do more harm than good for patients with the condition.
Nice said certain drugs do more harm than good for patients with the condition.

Nice has warned against prescribing a number of “commonly used drug treatments”, including paracetamol and ibuprofen, for chronic primary pain as they have “possible harms”.

A draft National Institute of health and Care Excellence (Nice) guidance published earlier this week (August 3), said patients with chronic primary pain should be offered “supervised group exercise programmes, some types of psychological therapy or acupuncture”.

These therapies should replace the prescribing of pain medicines such as paracetamol, non-steroidal anti-inflammatory drugs including ibuprofen and aspirin, benzodiazepines and opioids, Nice said.

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 there is evidence to suggest they cause harm, including possible addiction, Nice explained

Other drugs that should not be offered to patients with chronic primary pain – defined as pain that cannot “be accounted for by another diagnosis, or where it is not the symptom of an underlying condition” – include gabapentinoids, ketamine, corticosteroids, antipsychotics and local anaesthetics.

However, antidepressants may be considered for these patients, according to the draft guidance, which concerns the assessment and management of chronic pain in patients over the age of 16.

The draft guidance is now open to the public for consultation until September 14.

5 Comments
Question: 
What do you make of the draft guidance?

Tom Jerry, Community pharmacist

Like to see how Big Pharma will attack this!!!! bet they'll ask us to hand out an A5 pamphlet every time we sell a painkiller OTC.....soon. Personally  something's taken place in the background between the two to create a clinical pathway that works for them and the NHS considering the due length of the consultation and the media hype.

Leon The Apothecary, Student

In relation to prescribing habits, I can't see many clinicians moving away from analgesic usage when it has been effective in the past in managing chronic pain. 

Leon The Apothecary, Student

From what I've looked at recently, cannabis-based medicines for chronic pain management are the new scope of the future, although there is plenty of socio-economic and political issues to cross in regards to it, and a lack of data on the subject so far.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Oh, this is going to be a fun one! Does this mean that now, whenever someone asks for 32 paracetamol because the GP is refusing to prescribe, we have to try to persuade them to do a bit of stretching (or worse yet, psychological help) instead?? That's going to work like a dream isn't it? 

Alexander Dale, Dispenser Manager/ Dispensing Assistant

Stretching is just the first line treatment, then group therapy with other pain patients, then some OTC SSRIs if none of that helps!

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