Chronic pain pathway’s in the UK

On April 7th, the National Institute for Health and Care Excellence, or NICE, released their new guidance on the assessment and management of chronic primary pain.

After years of campaigning, the prospect of new, exciting, and meaningful pathways was an energizing one. However, upon review of the guidance, it is only disappointment that can be felt.

According to NICE, chronic pain is pain that lasts for more than 3 months. Chronic Pain can be secondary to an underlying condition, for example, osteoarthritis or endometriosis, or primary, with no clear underlying condition or with the pain appearing to be out of proportion to any observable injury or disease. Chronic primary pain and chronic secondary pain can coexist.

NICE admits that the mechanisms underlying chronic primary pain are only partially understood, with the definitions fairly new, however, this doesn’t mean it’s treatment plans have to be partially effective.

NICE’s proposals for chronic pain management are split into non-pharmacological and pharmacological treatments. The proposed non-pharmacological treatments are:

  • Exercise programmes and physical activity for chronic primary pain
  • Psychological therapy for chronic primary pain
  • Acupuncture for chronic primary pain

These treatment plans make sense from a lifestyle perspective, they help people come to terms with, and mentally fight, their pain.

However, my biggest issue with NICE’s recent announcement is it’s pharmacological approach, or apparent lack of.

Besides from the consideration of an anti-depressant, the extent of NICE’s pharmacological guidance is to “not initiate any of the following medicines to manage chronic primary pain in people aged 16 years and over:

  • antiepileptic drugs including gabapentinoids, unless gabapentinoids are offered as part of a clinical trial for complex regional pain syndrome
  • antipsychotic drugs
  • benzodiazepines
  • corticosteroid trigger point injections
  • ketamine
  • local anaesthetics (topical or intravenous), unless as part of a clinical trial for complex regional pain syndrome (see the recommendation for research on pharmacological interventions)
  • local anaesthetic/corticosteroid combination trigger point injections
  • non-steroidal anti-inflammatory drugs
  • opioids
  • paracetamol.”

This declaration is leaving people without treatment and is effectively telling people with pain to deal with it themselves, without providing them the resources to do so.

The government, NICE and the NHS must begin to take pain more seriously. More than two fifths of the UK population, or around 28 million adults, live with chronic pain, with UK estimates suggesting it costs the economy around £12 billion per year.

These figures will continue to rise if there is no meaningful pathway for the assessment and management of chronic primary pain. These pathways need to be both structural, through the affording of specific attention to pain services, and physical, with proper pain-relief techniques.

I truly believe that devices like BioWave could play a part in the UK’s pain services going forward, but until this is realised at a policy and political level, I fear more will fall into the pits of pain, with no ladder available for their escape.

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