treatment of chronic primary pain

The UK’s leading health advisory body recently published new guidance on the treatment of chronic primary pain which has raised some concern among pain management medical practitioners.

The National Institute for Health and Care Excellence (NICE) provides guidance and advice to improve health and social care and in April they published their guidelines on the assessment and management of chronic primary pain.

Understanding chronic primary pain

Chronic primary pain has no clear underlying condition and lasts for more than three months, whereas persistent pain that is the result of an underlying condition, such as arthritis or ulcerative colitis, is known as chronic secondary pain. Chronic primary pain is thought to affect between one and six per cent of the population.

NICE recommends that treatments that should be offered include exercise programmes, cognitive behavioural therapy and acupuncture. Although antidepressants should be considered, patients should not be prescribed pain relief medications such as paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids.

The argument is that “there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress, but they can cause harm, including possible addiction”.

Concerns over this new guidance

Doctors in pain management have raised concerns about the guidance. The British Pain Society, an alliance of professionals committed to advancing the understanding and management of pain for the benefit of patients, had the following statement:

“Chronic primary pain, that is chronic pain without an obvious cause, is difficult to diagnose, even for specialists. There is no single pathophysiological mechanism and no single test to identify it; each patient needs to be considered individually.

“Yet the guidance recommends that such patients should only be offered ‘antidepressants’, psychological therapies, acupuncture or group-based exercise. Whilst we support these inclusions, we regret the many evidence-based exclusions.”

The NICE guidelines emphasised that chronic primary pain is a challenging condition, and a clear diagnosis is not always possible, but there is a “need for shared decision making, putting patients at the centre of their care”. These guidelines echoes Dr Ivanova-Stoilova’s patient philosophy: “My patients are active participants in all discussions and treatment plans. The journey through pain is different for each patient and I am committed to correctly diagnose the pain syndrome, to assess its severity, duration and progression. My professional life is committed to making the patient with chronic pain live life and not just exist.”

For more advice, call 01633 820300 to arrange a consultation at the St Joseph’s Hospital, Newport.