New draft NICE guidelines for chronic pain emphasises exercise, CBT and acupuncture over medication

adambeyoncelowe said:
It looks like the neuropathic pain guideline is still in place? Ideally, pwME should try to get pain treated under that older guidance for the time being.

As such, I would suggest that pwME refer to their pain as burning and searing whenever they visit the doctor so that it is treated as neuropathic instead of 'chronic primary' pain.

We shouldn't have to, but unless there's a full 180 on this, many people might lose their medications.
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Thinking aloud, the 'primary' bit may be important. If our pain is 'secondary' and usually neuropathic in nature, then that may mean this guideline isn't applicable? It's another argument to be had with doctors, though.
 
To me the problem seems to be not in the concept of primary pain but in people being willing to accept very low standards of evidence for some treatments like CBT.

And also that medicine is so heavily driven by commercial interests, meaning that most of the attention is on finding treatments that allow someone to profit. There is little interest in finding out the real mechanisms, preventing disease and testing inexpensive treatment options.
 
It looks like the neuropathic pain guideline was updated in December 2019 so is still 'current': https://www.nice.org.uk/guidance/cg173

My guess is that the new guideline is supposed to be for conditions where pain is the primary symptom (e.g., FM, chronic cervical pain, etc). But the lack of specificity in the guideline title could result in any patient with pain being treated this way.

I wonder if FM charities will be challenging this?
 
BruceInOz said:
Is there evidence to support acupuncture for pain? I had the impression such evidence was rather poor. Am I wrong?
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Over 10 yrs ago, when my son was first ill with, he had chronic and severe headaches, diagnosed as cluster headaches. Along with medication, his consultant suggested we might try acupuncture as the most likely to help of the various alternative therapies. I did quite a lot of research myself and there was some support for it (better than most), so we did splash out and he agreed to try. The effect was immediate and dramatic, bringing immediate relief, and return to a normal life (he'd been missing about 1/3 days in school due to the the headaches, as well as feeling poorly -- this was classic boom and bust, but being focused on the headaches we didn't see it at the time. So, based on his experience, it did help with the pain, and he was able to come off the medication completely, and enjoy the rest of his last year of primary school.

However, about 6 months later he was hit by a nasty virus, and from then he was poorly for 5-6 years. We did try acupuncture again, but after 3 sessions it was evident it was not helping so we ended it. Fortunately he was spared the severe headaches, so pain wasn't an issue any more, except when he'd overdone.

We also had a longtime family friend with severe arthritis, and she found a lot of relief with monthly sessions along with medication. So for some people it does seem to help, but certainly not everyone.
 
adambeyoncelowe said:
My guess is that the new guideline is supposed to be for conditions where pain is the primary symptom (e.g., FM, chronic cervical pain, etc). But the lack of specificity in the guideline title could result in any patient with pain being treated this way.
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How many people have medical records that are both accurate enough and complete enough to actually let doctors know what has happened to the patient? How many people are assumed to be somatisers on the basis of incomplete records? When I bought my own GP records I discovered that there was some useful info buried in letters and operation notes but it had been summarised so poorly that only about 5% - 10% of what actually happened to me was clear. And of course, my medical records always, always, always trump anything I have to say to a doctor because some bastard decided I was a hypochondriac, a drug-seeker and an attention-seeker nearly 50 years ago.

I suspect that the suicide rate amongst the disabled and chronically ill is going to rise massively.
 
Arnie Pye said:
How many people have medical records that are both accurate enough and complete enough to actually let doctors know what has happened to the patient? How many people are assumed to be somatisers on the basis of incomplete records? When I bought my own GP records I discovered that there was some useful info buried in letters and operation notes but it had been summarised so poorly that only about 5% - 10% of what actually happened to me was clear. And of course, my medical records always, always, always trump anything I have to say to a doctor because some bastard decided I was a hypochondriac, a drug-seeker and an attention-seeker nearly 50 years ago.

I suspect that the suicide rate amongst the disabled and chronically ill is going to rise massively.
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Well exactly.
 
This site has a number of presentations that give a good overview of the BPS approach to chronic pain. Pharmac is the NZ centralised drug purchasing organisation - so it has an interest in minimising drug use.
https://www.pharmac.govt.nz/seminars/seminar-resources/chronic-pain/#presentation5

I found these videos gave me a much better understanding of what the BPS people are thinking and doing - as clinicians are talking to other clinicians. The arrogance is breath-taking at times. I can see that a little of what they propose might be useful for pain, but it goes horribly wrong when they try to apply it to ME/CFS or IBS.


 
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Esther12 said:
http://www.pulsetoday.co.uk/news/gp...s-for-chronic-pain-says-nice/20041262.article

I've not been impressed by the evidence that painkillers improve outcomes over the long-term for chronic pain, but I also think it's important that it's patients themselves who get to decide what is best for them.
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What is a long term outcome for chronic pain? If you take a painkiller and the pain goes away, it works. Even taking the edge of the pain is a worthwhile outcome.

I just don't understand what they are talking about. If you have a pain in your back all the time then something has gone wrong whether with your back or the pain signalling from your back.

I have never heard of anyone taking opiods for months in the hope that they will eventually work. Taking ibuprofen or paracetamol for a while so they reduce inflammation is a physical answer to a physical problem so I do not see why CBT would help.

Are they really saying that people must learn to live with their pain when a pill exists that would take it away?

Common sense would say that none of this applies to us as our pain is secondary to another illness but when did that stop them attacking us and making our lives worse. Frightened by this.
 
Covered on the BBC website

Chronic pain: Antidepressants not painkillers recommended
Doctors are being advised not to prescribe common painkillers, including paracetamol and ibuprofen, for patients with chronic pain not caused by an injury or other medical condition.

The National Institute of Health and Care Excellence (NICE) said there was little evidence they help.

And it suggests there is evidence long-term use can be harmful.

Its draft guidance for England recommends antidepressants, acupuncture or psychological therapy instead.
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https://www.bbc.co.uk/news/health-53649189
 
Mithriel said:
What is a long term outcome for chronic pain? If you take a painkiller and the pain goes away, it works. Even taking the edge of the pain is a worthwhile outcome.
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I seem to remember that long-term results for self-reported pain didn't tend to be better for those on pain medication than those not, but this is a memory of something I've not looked at for years.
 
So..people with long term pain don't suddenly not have long term pain after being given a pill, when you stop giving them pills?

Long term pain treatment isn't like a plaster cast for a broken leg.

It's more like oxygen for someone with COPD.

I would have suicided years ago without 'sort of' effective pain relief.

But doing so I suppose I would have saved the NHS a few quid a week - so swings and roundabouts.

Compared with many, many other drugs, not even the expensive ones, most painkillers cost pennies to the NHS - some may have a fairly high street value but that's only because they are illegal if not on prescription - the actual cost is not high - e.g. enough morphine to keep me relatively pain free, not totally, morphine at the amounts I take is useless for breakthrough pain, costs the NHS a little under £4 a month.

So this isn't a cost thing, it's not an evidence based thing that uses actual evidence - it's purely puritan doctrine
 
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