Antidepressants can be better than painkillers for chronic pain, suggests NICE

The National Institute for Health and Care Excellence (NICE) has warned that a range of commonly used painkillers for chronic pain ‘can do more harm than good’ and should not be used.

In draft guidance published in August, NICE said paracetamol, non-steroidal anti-inflammatory drugs (which include aspirin and ibuprofen), benzodiazepines or opioids should not be offered to those suffering from chronic primary pain.

Chronic primary pain is where the chronic pain is a condition in itself and can’t be accounted for by another diagnosis, or where it is not the symptom of an underlying condition (or what is known chronic secondary pain).

Examples included chronic widespread pain and chronic musculoskeletal pain, as well as conditions such as chronic pelvic pain, said NICE, and was also characterised by significant emotional distress and functional disability.

The guidance, which is being consulted upon until the middle of September, recommended that, instead, some antidepressants should be considered for people with chronic primary pain.

Acupuncture was also recommended as an option for some people with chronic primary pain, provided it was delivered within certain, clearly defined parameters.

The draft guideline also recommended that antiepileptic drugs, including gabapentinoids, local anaesthetics, ketamine, corticosteroids and antipsychotics, should not be offered to people to manage chronic primary pain. Again, this was because there was little or no evidence that these treatments work but could have possible harms.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: “What this draft guideline highlights is the fundamental importance of good communication to the experience of care for people with chronic pain.

“When many treatments are ineffective or not well tolerated it is important to get an understanding of how pain is affecting a person’s life and those around them because knowing what is important to the person is the first step in developing an effective care plan.

“Importantly the draft guideline also acknowledges the need for further research across the range of possible treatment options, reflecting both the lack of evidence in this area and the need to provide further choice for people with the condition,” he added.

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