In a group of new guidelines published in April, the National Institute for Health and Care Excellence (NICE) announced in its assessment and management of chronic pain that people with primary pain should be offered a range of treatments to help them manage their condition.

NICE recommends a range of effective treatments for people with chronic primary pain and calls on healthcare professionals to use an individualised approach and agree a whole person approach with the pain sufferer.

Here, Bob Rea, lead clinician and specialist pain management nurse at Our Health Hub, reacts to the NICE Guidelines:

Those suffering with persistent pain are concerned that the use of pain medicines is going to be restricted. There needs to be more informative discussions about why a move away from a mainly medicine-based approach is important. Patients need to be involved in this evolution and play an active part in their treatment including the role of any existing or new medicines. Each healthcare practitioner must consider the evidence for treatment with medicines for each pain sufferer. These guidelines are guidelines and not instructions to stop prescribing pain medicines.

The long-term use of strong pain medicines like opioids can lead to physical, psychological and social harms if left unchecked. A regular review is needed and prescribing healthcare professionals should be discussing possible benefits and harms of continuing to use this group of medicines. If a pain sufferer wants to make changes, they should be provided with information and support to do so.

Pain management is a broad discipline. There are many ways of treating persistent pain including physical therapies (physiotherapy, acupuncture, yoga, stretching exercises) and psychological approaches (CBT, ACT; Acceptance Commitment Therapy, etc) as well as social prescribed interventions such as community-based groups like yoga, pilates, walking or just meeting friends or making new ones. The NICE guidelines support this much wider approach.

It is important that people understand that, as with pharmaceutical medication, there are possible benefits but also possible adverse effects to all medicines or drugs. However, if people are properly educated to make balanced decisions then there are many alternative tools and techniques that pain sufferers find work for them and are all valid ways of managing pain. Speaking to people who are experts in the field and who are prepared to take a broad view will help towards reaching an informed decision.
The body is actually a treasure trove of substances that can help to control pain. These include endorphins and serotonin. Pain sufferers need to understand this and be educated in ways in which these natural substances can be used to produce the maximum benefit.

NICE is right in that it recommends a broad range of treatments should be used to treat persistent pain conditions. However, NICE seems to suggest an abrupt move from one way of doing things to another and this may cause people to panic. It should also acknowledge that medication can have a role to play in a person’s treatment plan.

Mr Rea concludes: “There has to be a process of engaging pain sufferers to generate a best practice clinical approach. The system needs to be changed so that it is much more informative, educative and empowering for pain sufferers – but this may be difficult given the many constraints on NHS-funded GPs and primary care services, such as short consultation times. As a private service, Our Health Hub emphasises the importance of engagement in its approach because time and education are the cornerstones of the way we provide pain management.”