Our view on the NICE Chronic Pain Guideline

07 April 2021
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On Wednesday 7 April, NICE published a new guideline for clinicians, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. This makes a number of recommendations on the assessment and management of primary chronic pain.

It's important to state that this guideline applies to England only and other UK nations may take a different approach to the findings and recommendations made by NICE.

In this article we outline the key points of the new guideline, our views and what we're doing to support people living with different forms of chronic pain.

What does the guideline say?

The guideline covers the assessment of both primary and secondary chronic pain, but only the management of chronic primary pain, such as fibromyalgia.

It was produced following a review of evidence around the management of chronic primary pain and includes a number of recommendations about supporting people to self-manage their chronic pain, care planning, the use of pain relief and other medication, as well as programmes to support exercise.

For more information on definitions of primary and secondary pain, see the context section (pg 5) within the NICE guideline document.

Our views on the guideline

The impact of chronic pain can impact different people in different ways. We therefore welcome that the assessment of chronic pain will involve a personalised approach, captured in a jointly agreed care and support plan between a person with chronic pain and a healthcare professional. A tailored approach is needed given the different symptoms and ways in which on-going persistent pain can impact on a person’s life.

We're aware that some people who already use certain medication to manage their chronic primary pain may worry about what will happen to their treatment and whether their prescriptions might be altered, or even stopped.

However, any review of the medication people are taking to manage their chronic primary pain must include a conversation based on shared decision-making between the healthcare professional and the person living with chronic primary pain: where people currently experience a benefit from their medication and no significant harms things are not likely to change.

People living with chronic primary pain must be given the chance to discuss their concerns with a healthcare professional so that a shared decision can be reached.

The recommendations set out in the guideline about the need for further research into what treatments work for pain, illustrate just how little is still known about the causes and best treatments for chronic pain.

We therefore welcome the guideline’s recommendations for further research and hope that agencies such as NIHR will fund this vital research given the socio-economic and health impacts of chronic pain on society, individuals and families.

What is Versus Arthritis doing?

We will shortly be publishing a report on the impact of chronic pain on people’s lives and what we would like to see change.

We've also been taking the lead around pain research, setting the agenda through the Pain Roadmap (PDF, 1.6 MB) which highlights the progress needed in research and public health measures on chronic pain.

We've also partnered with UKRI to co-fund the £24 million “Advanced Pain Discovery Platform” focusing on generating discoveries and early translational science into new treatments for chronic pain.

Through our helpline, virtual assistant, website and community groups, we provide support and information to people living with pain.

Q&A

What do we mean by chronic pain? What is primary chronic pain? How does it differ from secondary pain?

Chronic pain usually refers to persistent or recurrent pain that has gone on for more than three months.  

Some chronic pain is caused by underlying inflammation or damage to the body’s tissues, through injury for example. In arthritis there is inflammation or damage in the joints, and neuropathic pain can be caused by damage to the nerves. This type of pain is normally called chronic secondary pain.

However, some types of chronic pain, generally known as chronic primary pain, have no specific cause, for example fibromyalgia. These are conditions in their own right, where the chronic pain is complex and may be associated with many other symptoms, rather than being due to underlying disease or damage in the joints or nerves.

Chronic primary pain also includes other types of musculoskeletal pain (such as back pain) where no specific cause has been identified.

Whilst this guideline covers the assessment of both chronic primary and secondary pain, the new NICE guideline about management specifically focuses on chronic primary pain such as fibromyalgia. It’s estimated that somewhere between 1.8 million and 2.9 million people in the UK have fibromyalgia.

Why is exercise good for my chronic pain?

Many studies have shown that exercise can help to reduce pain, improve quality of life and help people to get a better night’s sleep.

In contrast, lack of exercise can lead to progressive loss of fitness and weakening of the muscles and even the bones – potentially leading to worsening pain or developing other musculoskeletal health problems such as osteoporosis.

As long as exercise begins at a level that is tailored to a person’s physical ability and health needs, and then increased gradually, there are unlikely to be any negative effects of exercise.

The guideline also acknowledged that many people with chronic primary pain find it hard to be physically active, and that it is important for physical activity to be sustainable for the person.

Read more about ways to stay active with arthritis.

Will I be able to stay on the medication I find helpful for my chronic pain?

We want to reassure anyone who is already taking certain medications for their chronic primary pain, that the prescribing of their medication will continue, where there are benefits to the patient and no evidence of any harm.

As part of ongoing prescription reviews with your clinician, the benefits and risks of different drugs should be discussed and all decisions regarding treatment should be made as part of a shared conversation between you and your healthcare professional.

People living with pain must be given the chance to discuss any concerns with a healthcare professional so that a shared decision can be reached.

The guideline suggests acupuncture, and CBT are treatment options for helping to manage my chronic pain? Where do I access these services?

Pain management services are accessed by referral from your GP, who can also offer a supervised exercise programme tailored to your needs and abilities.

Acupuncture is sometimes available on the NHS, via GP practices or physiotherapists and the guideline suggests that a single course of acupuncture or dry needling should be considered for people aged 16 years and over to help them manage their chronic primary pain.

However, many people who have acupuncture pay for private treatment. You can find an acupuncturist through the British Acupuncture Council.

Your GP can refer you for Cognitive Behavioural Therapy (CBT) or you can refer yourself through the NHS.

You can also access services via charities and organisations like us.

We’re here for you