Painkillers from paracetamol to opioids should no longer be prescribed by GPs for chronic pain.
The first-ever NICE ruling on chronic pain concluded there was no evidence pills including ibuprofen “made any difference to people’s quality of life, pain or psychological distress”.
The long-awaited draft guidance found there was evidence that painkillers cause harm, including addiction.
The ruling is seen as an attempt to wean Brits off from being a nation of pill poppers.
It relates to “chronic primary pain” suffered by millions and for which medics cannot pinpoint a specific cause.
Many have suffered for decades with back and pelvic pain.
Such prescriptions had soared in the last decade but from now on GPs should offer supervised group exercise programmes, counselling or acupuncture.
Nick Kosky, a consultant psychiatrist 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.”
The full list of drugs affected
Drugs included in the guidance which should no longer be offered were:
- Non-steroidal anti-inflammatory drugs
- Anti-epileptic drugs including gabapentinoids, unless gabapentinoids are offered as part of a clinical trial for complex regional pain syndrome
- Local anaesthetics, by any route, unless as part of a clinical trial for complex regional pain syndrome
- Local anaesthetic/corticosteroid combinations
GPs should now explain the ‘risks of continuing’ to those already taking any of these medicines, the guidance said.
It added: “If a shared decision is made to stop antidepressants, opioids, gabapentinoids or benzodiazepines, be aware of the problems associated with withdrawal.”
It follows Public Health England’s landmark review into prescription drug addiction last year.
It concluded that one in four adults – over 11 million adults in England – received a prescription for antidepressants, opioids, gabapentinoids, benzodiazepines or z-drugs in the previous year.
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.”
The guidance is open for consultation until 14 August.