NHS health officials say paracetamol, ibuprofen and opioids also unsuitable for chronic primary pain

Painkillers such as paracetamol, ibuprofen, aspirin and opioids can do “more harm than good” and should not be prescribed to treat chronic primary pain, health officials have said.

The National Institute for Health and Care Excellence (Nice) said there was “little or no evidence” the commonly used drugs for chronic primary pain made any difference to people’s quality of life, pain or psychological distress.

But the draft guidance, published on Monday, said there was evidence they can cause harm, including addiction.

Chronic primary pain is a condition in itself that cannot be accounted for by another diagnosis or as a symptom of an underlying condition, Nice said. It is characterised by significant emotional distress and functional disability with examples including chronic widespread pain and chronic musculoskeletal pain.

The chairman of the guidance committee, Nick Kosky, said that, while patients expected a clear diagnosis and effective treatment, the complexity of the condition means GPs and specialists can find it very “challenging” to manage.

The consultant psychiatrist at Dorset Healthcare NHS University foundation trust added: “This mismatch between patient expectations and treatment outcomes can affect the relationship between healthcare professionals and patients, a possible consequence of which is the prescribing of ineffective but harmful drugs.

“This guideline, by fostering a clearer understanding of the evidence for the effectiveness of chronic pain treatments, will help to improve the confidence of healthcare professionals in their conversations with patients.

“In doing so it will help them better manage both their own and their patients’ expectations.”

Nice said an estimated third to half of the population may be affected by chronic pain while almost half of people with the condition have a diagnosis of depression and two-thirds are unable to work because of it.

The draft guidance, which is open to public consultation until 14 September, said that people with chronic primary pain should be offered supervised group exercise programmes, some types of psychological therapy, or acupuncture.

It also recommends that some antidepressants can be considered for people with chronic primary pain.

But it said that paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, benzodiazepines or opioids should not be offered because there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress.

There was evidence that they can cause harm, including possible addiction, it added.

The draft guideline also said that anti-epileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and anti-psychotics should not be offered to people to manage chronic primary pain because, again, there was little or no evidence that these treatments work but could have possible harms.

Dr Paul Chrisp, director of the centre for guidelines at Nice, said: “When many treatments are ineffective or not well-tolerated, it is important to get an understanding of how pain is affecting a person’s life and those around them because knowing what is important to the person is the first step in developing an effective care plan.

“Importantly the draft guideline also acknowledges the need for further research across the range of possible treatment options, reflecting both the lack of evidence in this area and the need to provide further choice for people with the condition.”

• This article was amended on 4 August 2020 to emphasise that the draft guidance from Nice refers to chronic primary pain. The word “primary” was added to the headline and subhead. A link to the relevant page of Nice’s website was also inserted in the third paragraph.
• This article was further amended on 4 August 2020 to say the draft guidance is open to public consultation until 14 September, not 14 August as we first reported.