New NICE guidelines advise drug treatments ‘ineffective’ for chronic primary pain

New draft guidelines issued for consultation by the National Institute for Health and Care Excellence (NICE) advise against the use of many routine drugs for chronic primary pain. This includes paracetamol, non-steroidal anti-inflammatory drugs (i.e aspirin and ibuprofen) benzodiazepines or opioids. The guidelines state these should not be offered because there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress.

What is chronic primary pain?

Chronic primary pain is “a condition in itself which cannot be accounted for by another diagnosis or as a symptom of an underlying condition”, NICE states. It has a real impact on one’s quality of life, causing significant emotional distress and functional disability.


Do painkillers really do more harm than good?

Painkillers are easy to access and low cost, making them what appears to be the winning choice for managing musculoskeletal pain. Until we look at the evidence, that is…

chronic primary pain painkillersThere is a growing body of research that shows that for many patients, other types of treatment produce better outcomes. When it comes to back pain in particular, spinal injections, opioids, and surgery aren’t helping us beat the burden of low back pain. Musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability globally. (WHO, 2017)

Painkillers can be beneficial for some. As an example, weaker opioids (with or without paracetamol) should only be used when NSAIDs cannot be tolerated, are contraindicated or have been ineffective.

You can also build a tolerance to painkillers, meaning patients take a higher or more frequent dose. There is also a phenomenon called “opioid induced hyperalgesia”. This is where an increase in pain is seen due to a change in the normal function of cellular and molecular pain mechanisms. This happens as a result of prolonged opioid exposure. It can result in patients perceiving increased pain levels than what they had originally.

How does this affect me?

The draft guidelines continue to highlight the importance of the relationship between patient and practitioner. This ensures you are put at the centre of your care, with a collaborative, supportive relationship with your practitioner to help you manage your pain.

The draft guideline emphasises the importance of putting you at the centre of your care. Equally important is having a collaborative, supportive relationship with your healthcare professional. This is something we prioritise at Acorn Health. We understand how important it is you have trust and confidence in those working with you.

Research shows that the more you know and understand your pain, the better you can control and cope with it. Understanding pain also means understanding the treatment options available to you. This helps avoid a disconnect between your expectations and the care options you have available to you. This knowledge will empower you to take an active role in choosing a path that works for you.

What treatment works for chronic primary pain?

There are many options available to you. The draft guidelines recommend structured, supervised exercise programmes and psychological based therapies. Acupuncture is also recommended for some, provided it is delivered within certain, clearly defined parameters.

chronic primary pain chiropractor painkillersMany studies show that Chiropractors are well positioned to help with these situations, working with you to find the most effective self-management solution. We provide a package of evidence-based interventions which incorporate the above recommendations and can improve the management of your pain.

We give you the time and space to discuss the history of your pain. By discussing how it affects you and your goals for the future, we can identify a road to recovery. Incorporating Pain Management Coaching, our Chiropractor can help you identify what barriers there are to improvement- which may be ingrained in your thoughts, fears and feelings surrounding your pain.

These approaches have been proven time and time again to be an effective solution for chronic pain.

A word from Philippa

For more information on this and how it affects you, watch our accompanying video below.


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