Doctors warned that painkillers should not be given to people with chronic pain - here’s why

Wednesday, 5th August 2020, 3:40 pm
Updated Wednesday, 5th August 2020, 3:40 pm
Painkillers, including paracetamol, ibuprofen and aspirin, are commonly taken by people experiencing pain (Photo: Shutterstock)

Painkillers, including paracetamol, ibuprofen and aspirin, are commonly taken by people experiencing pain.

However, health officials have now said that they should not be prescribed for chronic pain, as they can do “more harm than good”.

Sign up to our public interest bulletins - get the latest news on the Coronavirus

Sign up to our public interest bulletins - get the latest news on the Coronavirus

Little evidence that painkillers help chronic pain

The National Institute for Health and Care Excellence (Nice) said there was “little or no evidence” that painkillers commonly used for chronic primary pain made any difference to the quality of people’s lives, their pain or psychological distress.

The recently published draft guidance instead noted that there was evidence that these painkillers can cause harm, including addiction.

What is chronic pain?

Nice said an estimated third to half of the population may be affected by chronic pain.

Alongside this, almost half of people with chronic pain have a diagnosis of depression, with two-thirds unable to work because of it.

Nhsinform.scot explains, “Chronic or persistent pain is pain that carries on for longer than 12 weeks despite medication or treatment.

“Most people get back to normal after pain following an injury or operation. But sometimes the pain carries on for longer or comes on without any history of an injury or operation.”

The NHS notes that lying in bed for long periods may actually make the pain last longer because inactivity can make you stiffen up, “your muscles and bones get weaker, you don't sleep well, you become lonely and depressed, and the pain feels worse”.

‘Prescribing of ineffective but harmful drugs’

The draft guidance, which is open to public consultation until 14 September, said that people who have chronic primary pain should be offered supervised group exercise programmes, acupuncture or some types of psychological therapy.

The guidance also recommends that some antidepressants can be considered for people with chronic primary pain.

However, it said that paracetamol and non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen should not be offered to those with chronic primary pain as there was little or no evidence that they made any difference.

Alongside this, the draft guideline said that anti-epileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics should not be offered to people to manage chronic primary pain.

This is again because there was little or no evidence that these treatments work, but could instead cause possible harm.

Nick Kosky, a consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust and chair of the guideline committee said: “Understandably, people with chronic pain expect a clear diagnosis and effective treatment. But its complexity and the fact GPs and specialists alike find chronic pain very challenging to manage, means this is often not possible.

“This mismatch between patient expectations and treatment outcomes can affect the relationship between healthcare professionals and patients, a possible consequence of which is the prescribing of ineffective but harmful drugs.”