NICE (National Institute for Health and Care Excellence) publishes health guidelines for the NHS. They released draft guidelines for Chronic Pain Management in August this year. These guidelines are up for discussion until they become fixed recommendations in January 2021. Reading through them makes for interesting and encouraging reading as lower cost, less noxious solutions are favoured over the typical pharmacological solutions.
So, what’s in the guidelines and what’s been left out this year?
Pain management programmes have been removed from the guidelines due to the very small benefit noted in trials.
Social Interventions, otherwise known as social prescribing have not been recommended purely due to lack of trials proving efficacy. I’m a fan of social prescribe-ing as it allows GPs to look more holistically at a patient’s health and put them in touch with link workers who can suggest organisations and charities that may be able to help the patient further.
Massage was not recommended due to inconsistent evidence. It’s very difficult to judge massage objectively as there are so many different schools and therapist’s skill can diverge massively.
Many medications. Steroids, benzodiazepines, NSAIDS and opioids amongst others. I’m so happy that addictive substances such as opioids, benzodiazepines and gabapentin are off the list. The guidelines note insufficient evidence for their efficacy and a real danger of drug dependency and some negative impacts on psychological and physical functioning.
Psychological Interventions including ACT (Acceptance and Commitment Therapy) and Cognitive Behavioural Therapy (CBT) are proven to be effective.
Exercise. Much like acupuncture exercise has a wealth of positive studies (23 in total) underlining improvements in pain levels and quality of life. The majority of these studies were focused on fibro-myalgia. The main issue I foresee is convincing patients of the benefits of exercise. The last thing someone with chronic pain wants to instinctively do is pop on their gym clothes and start exercising. Fatigue, depression and increased pain perception are frequent barriers.
Many chronic systemic pain sufferers (such as fibromylagia, post viral fatigue) are highly sensitive to exercise. It’s really easy to over-stress an already stressed body and do more harm than good. Sensitive “dosing” of exercise may well be as important for this subsection of pain sufferers as it was previously for medications.
Acupuncture has been recommended by NICE in the past – but always for specific conditions such as back pain. NICE currently recommends acupuncture for treatment of migraine and tension headache.
To have a blanket recommendation for chronic pain is a rare endorsement from the western medical establishment. As they themselves noted “Overall, the committee agreed that there was a large evidence base showing acupuncture to be clinically effective in the short term” and “Many studies (27 in total) showed that acupuncture reduced pain and improved quality of life in the short term (3 months) compared with usual care”.
You can see the full text detailing NICE recommendations here:
www.goweracupuncture.co./ firstname.lastname@example.org / 07764 254881