Common pain medicines — such as paracetamol, non-steroidal anti-inflammatory drugs including aspirin and ibuprofen, benzodiazepines, and opioids — should not be offered to patients with chronic primary pain, according to National Institute for Health and Care Excellence (NICE) draft guidance.
But exercise, psychological therapies such as cognitive behavioural therapy (CBT), and acupuncture should be offered, says the draft guidance, published on 4 August 2020.
The guidance, on managing chronic pain in patients aged over 16, concluded that there was little evidence that many of the commonly prescribed drugs made a difference to the patient’s quality of life — but that there was evidence they can lead to problems, including the risk of addiction.
It also recommends avoiding the use of antiepileptic drugs, including gabapentinoids, again because of “limited evidence” that they offer relief. But it says that certain antidepressants, such as commonly prescribed selective serotonin reuptake inhibitors, can be prescribed off-label after patient and prescriber have had a “full discussion of the benefits and risks”.