NICE Guidelines For Treating Chronic Pain Could Destroy People

In the UK, doctors follow NICE (National Institure for Health and Care Excellence) guidelines when prescribing medication or treatments. Patients can also refer to the guidelines. However, NICE has drawn up a draft of new guidelines for treating chronic primary pain. These new guidelines are shocking and could, actually, will, destroy some people and I believe that NICE need to reconsider them.

I first read about the planned changes when I saw a petition by a woman called Claire Swain. Claire has worked so hard trying to get people to take notice of the proposed changes. She has worked diligently to gather information and start petitions. (You can read about her efforts here.)

Her last petition to the UK parliament didn’t get enough signatures. I don’t understand why because this is a serious issue. We need to fight this. Claire has now created a new petition.

Please, sign it, share it and ask your family and friends to do the same.
Petition for UK Parliament

The Draft NICE Guidelines for Treating Chronic Primary Pain Seem Unethical

When I read the proposed NICE guidelines for treating chronic primary pain, I was shocked.

In the first section of the draft, they say this:

“The guideline aims to reduce distress and improve quality of life by ensuring a care plan informed by a person’s individual priorities, strengths, preferences, interests and abilities.”

That sounds good, but what they are suggesting seems to be the opposite. What they are suggesting actually seems criminal and unethical and could harm people living with chronic pain.

What is Chronic Primary Pain?

Chronic pain is pain that persists or recurs for more than 3 months. However, there are several types of chronic pain.

Chronic primary pain is classed as a disease in itself. A diagnosis of chronic primary pain is given when long-lasting pain cannot be diagnosed as another condition.

If chronic pain is a symptom of a specific condition, it’s called chronic secondary pain.

Who Could the New NICE Guidelines Affect?

The proposed guidelines could affect patients diagnosed with chronic primary pain.

NICE has guidelines for many conditions which cause chronic secondary pain. However, if NICE does not have a guideline for a specific condition, then the chronic primary pain guidelines will also apply.

What Are the New Guidelines From NICE for Treating Chronic Primary Pain?

NICE make suggestions which will only involve “non-pharmacological management of chronic primary pain”.

In other words, NICE advises doctors not to prescribe medication.

The NICE Guidelines for Treating Chronic Pain – No Pain Medication

The following is an extract from the draft guidelines.

Do not offer any of the following, by any route, to people aged 16 years and over to manage chronic primary pain:

• opioids
• non-steroidal anti-inflammatory drugs
• benzodiazepines
• anti-epileptic drugs including gabapentinoids, unless gabapentinoids are offered as part of a clinical trial for complex regional pain syndrome
• local anaesthetics, by any route, unless as part of a clinical trial for complex regional pain syndrome
• local anaesthetic/corticosteroid combinations
• paracetamol
• ketamine
• corticosteroids
• antipsychotics

What The Guidelines Also Say About Medication

It’s important to note that the guidelines state that patients do not necessarily have to stop taking medication listed if they already have been prescribed.

“If a person with chronic primary pain is already taking any of the medicines listed above, a doctor should explain the risks of continuing.
Then, if a shared decision is made to stop antidepressants, opioids, gabapentinoids or benzodiazepines, be aware of the problems associated with withdrawal.”

However, as patients, we know how shared decisions often work. They are not shared. It often sounds more like, “I have to stop prescribing that medication.” And there is often no, or very little advice given about stopping the medication.

What Else is in the Guidelines for Treating Chronic Pain?

No Electric Equipment for Pain Relief

As well as removing pain medication, the new NICE guidelines also say that electrical physical modalities will not be offered or suggested. Those are:

• TENS
• ultrasound
• interferential therapy

No Cannabis Products

This part of the guidelines probably doesn’t come as a shock to anyone.

“No evidence was identified on the effectiveness of cannabis-based products for chronic primary pain. Some evidence suggested that the treatment could cause adverse events in the short term. However, this was limited evidence from a small study. Although the committee agreed that more research would be useful to inform future practice, it was decided this was adequately covered within the NICE guideline on cannabis-based medicinal products.”

What the NICE Guidelines Suggest for Treating Chronic Primary Pain

Nice are suggesting four types of treatment:

• Antidepressants
• Exercise
• Psychological therapy
• Acupuncture

Antidepressants

Antidepressants are the only medication suggested.

“An antidepressant, either duloxetine, fluoxetine, paroxetine,
citalopram, sertraline or amitriptyline may be used to manage chronic primary pain after a full discussion of the benefits and risks.”

Exercise

“Offer a supervised group exercise programme (for example, cardiovascular, mind–body, strength, or a combination of approaches) to people aged 16 years and over to manage chronic primary pain. Take people’s specific needs, preferences and abilities into account. Encourage people with chronic primary pain to carry on with their exercise for longer-term general health benefits”

Psychological Therapy

“Consider acceptance and commitment therapy (ACT) or cognitive-behavioural therapy (CBT) for pain for people aged 16 years and over with chronic primary pain.”

Acupuncture

“Consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system but only if the course:
is delivered in a community setting
delivered by a band 7 (or lower) healthcare professional, and
is made up of no more than 5 hours of healthcare professional time”

I Am Not Against Those Treatments

Living with chronic pain is difficult. Treating chronic pain is also difficult. Good pain management normally entails a variety of tools like breathing and relaxation techniques as well as the suggestions which NICE is making. People will benefit from those suggestions.

However, to stop prescribing any form of pain medication is cruel and unethical. The treatment of chronic pain should surely be based on an individual’s needs. And most people who live with continuous pain need pain relief.

There is More to Chronic Pain Than Just Pain

I Need Medication to Help My Pain

The draft guidelines could affect many people who live with chronic pain. They could affect me because I take some of the medications listed.

I am actually scared to even imagine what my life could be like without medication.

My pain is widespread, from my feet to my head and almost everywhere in between. I’ve developed a lot of coping skills such as breathing techniques, using distractions and simply listening to what my body is telling me. But I couldn’t manage those things without also using medication.

Life is difficult. I struggle daily. Most people living with chronic pain are the same. Many of them much worse than myself.

What NICE Says About Chronic Pain

NICE guidelines state the following about chronic pain:

“Chronic pain is often difficult to treat. It can be associated with many different types of tissue injuries and disease processes. Sometimes no underlying disease can be found. Pain has a significant impact on individuals and their families and carers. It affects mood, sleep, mobility, role within the family, ability to work and other aspects of life.”

Reading that, you’d think that NICE have their finger on the pulse. They know exactly how chronic pain affects people’s lives. But if that’s the case, why would NICE remove any form of pain medication from the guidelines?

Are they wanting to stop prescribing medication because of the cost? Perhaps they are concerned about side effects or possible dependency? Or is it because they believe chronic pain patients are simply choosing to take medication?

Pain Patients DO NOT Choose to Take Medication

We take medication knowing that there may be risks attached. And sometimes the side effects are almost as bad as the pain. But I don’t know any chronic pain sufferer who takes medication through choice.

Imagine Living With Chronic Pain Without Access to Medication

Please try to imagine a life of uncontrolled pain. Imagine the pain going on and on, with no end in sight. You would hope that doctors would help you, wouldn’t you?

That’s all we’re asking – that doctors help us.

What Other People Say About the NICE Guidelines for Treating Chronic Pain

Patients are not the only people with concerns.

Professional bodies also have concerns about the draft guidelines. You can read the following reports:

• The Pharmaceutical Journal
  “The RPS went on to say that the “lack of clarity” would result in a “large proportion of the population” who have chronic pain from a specific cause being denied the appropriate analgesics.”
• The Faculty of Pain Medicine
  “The guidance recommends discounting some treatments currently used quite widely, e.g. some pharmacological therapies and electrical physical modalities. This will be challenging and may discourage patients if the alternative treatments which are recommended are not available in a timely manner, e.g. CBT therapy. The risk of this may be greater if the original and new treatments are provided by different organisations.”
• The Royal College of General Practitioners
  “Most patients in pain do not want to take medication long-term, and GPs do not want this either, but sometimes medication has been the only thing that brings relief.”
• Pulse Today – RCGP Chair, Professor Martin Marshall
  “He added that although GPs are ‘aware’ of the risks of prescribing pain medication and discuss this with patients, it is sometimes ‘the only thing that brings relief’.”

How Can You Help?

Please sign Claire Swain’s petition because those new guidelines will destroy people. It is important that NICE take another look and alter this draft.

You could also write to MPs, newspapers or tv news shows because people need to hear about this so that changes can be made.

What’s Your Opinion?

How do you feel about the draft guidelines from NICE for treating chronic pain? Please let me know in the comments below.