August 10, 2020

Treating chronic pain is difficult – NICE’s guidance on pain medication assumes it’s simple

Sadly more than 20 million people in Britain suffer from chronic pain which has a significant physical and mental impact upon their wellbeing. GPs have recently been advised by health officials that common painkillers such as paracetamol, aspirin, ibuprofen, and opioids may do more harm than good for people with chronic pain.

The guidance – is it the right move?

The National Institute for Care Excellence (NICE) argues in recent draft guidance that, according to their research, common painkillers do little to help people with chronic pain cope with their physical and psychological symptoms. Furthermore, they have found evidence that the medication could even cause harm, including the possibility of addiction.

As solicitors who represent many clients with varying degrees of chronic pain, we would stress the importance of taking every case on an individual basis. Any patient who presents with chronic pain, and who is struggling to cope, should listen to their doctors, or another clinician who understands pain, first and see what works for them.

We asked Richmond Stace, a specialist pain physio who we have often worked with, his opinion on the guidance:

“Drugs can and do play a role if used sensibly: one, as part of a plan with regular reviews; two, making sure the patient understands how they work, why they are using them and for how long before a review, and; three, monitoring for side-effects.

We cannot take away people’s ways of coping as this is very threatening, but we can add choices.”

Alternatives to pain medication

It is of interest that, as part of the guidance, NICE have recommended supervised group exercise programmes, some types of psychological therapy, and acupuncture to be used as ‘alternative’ forms of therapy for chronic pain.

Whilst COVID-19 and lockdown have obviously made it difficult for many treatments to continue, it is encouraging that NICE have advised alternative treatments for chronic pain. Fortunately, many physiotherapists and Psychologists are able to offer remote consultations which our clients continue to find beneficial.

Over the years, our clients have benefited greatly from rehabilitation programmes at the Royal National Hospital for the treatment of Rheumatic Diseases in Bath (the centre has now moved to the Royal United Hospital) - with which we have close contact. Their programmes are offer treatments for chronic pain and CRPS beyond pain medication, helping patients to develop an understanding of their pain and how to manage it as they move forward with their lives.

For our clients we have also secured interim payments from insurers to fund three-week pain management programmes they can attend, organised with private provider Real Health. These programmes have enabled them to develop multidisciplinary techniques to help them manage their pain and pace their activities.

We asked Richmond about this different approach to treating chronic pain:

“There are many choices that empower and encourage the person: help them understand their pain, movement, exercise, breathing practices, mindfulness, self-coaching skills, periodising and prioritising activities each day/week, skills of being well.

However, using the word ‘alternative’ suggests a ‘mainstream’ treatment for chronic pain. Starting with the biomedical model as ‘mainstream’, people head down the wrong route, searching for an injury or structure to explain their pain. This is wrong: pain and injury are poorly related.

Through a range of treatment, we can focus on empowering and encouraging the person to improve their life and even go beyond helping people ‘manage’. They may have to ‘manage’ a particular moment, but overall, what are they working towards? That’s their decision: the ideal future. Otherwise, they are aiming low.”

Whilst a renewed focus on the treatment of chronic pain is welcome, this isn’t a black and white issue. A blanket approach to prescribing, or not prescribing, medication may unfortunately do just as much harm as the current approach NICE is trying to address, as it plays one role within an overall treatment programme. For example many of our CRPS clients who undergo many kinds of treatment, including physical therapy, find that liquid paracetamol really works for them but is actually very hard to get.

We hope that, during the consultation period for this draft guidance (which ends on 14 August), NICE hears feedback which allows them to refine their recommended approach to treating chronic pain.

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