Painkillers should not be prescribed for chronic pain because they may do 'more ...

Painkillers such as paracetamol and ibuprofen can do 'more harm than good' and should not be prescribed to treat chronic pain, health officials have said.

The National Institute for Health and Care Excellence claims that there is 'little or no evidence' the drugs, as well as aspirin and opioids, work.  

But in draft guidance, published on Monday, Nice said there was evidence painkillers can cause harm, including addiction.

It says it would be 'inappropriate' for them to offered to patients anymore, despite the NHS saying paracetamol is safe when taken over many years.

Nice suggests people with chronic pain are instead offered exercise classes, therapy, acupuncture or even antidepressants. 

Painkillers such as paracetamol and ibuprofen can do 'more harm than good' and should not be prescribed to treat chronic pain, health officials have said (stock)

Painkillers such as paracetamol and ibuprofen can do 'more harm than good' and should not be prescribed to treat chronic pain, health officials have said (stock)

Chronic primary pain is a condition in itself which cannot be accounted for by another diagnosis or as a symptom of an underlying condition, Nice said.

Doctors often define chronic pain as any pain that lasts for three to six months or more.  

It is notoriously difficult to treat, and is characterised by significant emotional distress and functional disability.

Nice said an estimated third to half of the population may be affected by chronic pain while almost half of people with the condition have a diagnosis of depression and two-thirds are unable to work because of it.

The draft guidance, which is open to public consultation until August 14, said that paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen, benzodiazepines or opioids should not be offered to people with chronic pain. 

There is little or no evidence that they made any difference to people's quality of life, pain or psychological distress, the guidance said, and in some cases are harmful.

Studies have suggested that patients who took benzodiazepines and NSAIDS had poorer psychological and physical functioning. 

The guidance did not give details about how paracetamol is harmful. However, it is known that overdosing on paracetamol can cause serious side effects. 

WHAT DOES THE NHS  RECOMMEND FOR CHRONIC PAIN?

The NHS recommends a combination of the following to manage chronic pain:

Exercise: Walking, swimming, using an exercise bike, dancing, yoga or pilates should become part of a patient's everyday life - even on their bad days - to help them stay out of bed despite their pain. 

'But try to avoid overdoing it on good days and paying for this by having more bad days,' the website says. 

Going to work: Research shows that people become less active and more depressed when they don't work.

Being at work can help distract from the pain, and in most cases, won't make the pain worse.

A person with chronic pain can talk to their employer about how they can work in a way that suits them, for instance changing their shift patterns.  

Physical therapy: Pain experts often recommend a short course of physical therapy to help a patient move better and make tasks and activities like walking, going up stairs or getting in and out of bed easier.

Physical therapy for persistent pain can involve manipulation, stretching exercises and pain-relief exercises.

Physical therapy is usually delivered by a physiotherapist, chiropractor or osteopath, or in some cases, an occupational therapist. 

Painkillers for long-term pain: The NHS says 'it's safe to use over-the-counter painkillers to reduce your pain so you can be more active.

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