Chronic pain – defined as pain that lasts for more than three months – is debilitating, common, and often proves very difficult to treat.
Doctors split pain into two camps. Secondary pain is linked to an underlying condition so it is often clear what can be done to help.
But primary pain is where there’s no known underlying condition – which poses problems of what to do.
In April, NICE published guidelines for primary pain treatment which will be useful for anyone living with this debilitating problem.
It emphasised building a collaborative and supportive relationship with your doctor and carers.
It also stressed the importance of supervised group exercise to people with pain, and other than antidepressants, drugs aren’t recommended.
This is because most medicines don’t have any benefit in the management of chronic pain.
Some drugs also carry a risk of harm, such as misuse and dependence as with opioids and gabapentinoids.
The report said if you suffer from pain over many months a care plan drawn up by you and your doctor together is the mainstay of management. In this plan your specific needs, preferences and abilities are taken into account by your doctor.
Always worth considering are non-drug treatments such as acceptance and commitment therapy, and cognitive behavioural therapy – both of which can be arranged by your GP.
The guidelines also suggest a single course of acupuncture or dry needling, by a traditional Chinese or Western acupuncturist, but only if the course is in a community setting and carried out by a healthcare professional.
We should remember there’s no evidence that TENS machines (transcutaneous electrical nerve stimulation), ultrasound therapy and interferential therapy are effective.
You and your doctor could jointly consider an antidepressant after making sure you understand the benefits and potential harms.
If you do opt for an antidepressant it may not only help relieve your pain but also improve your quality of life, sleep, and psychological distress, even if you haven’t been diagnosed with depression.
If you’re already taking medication for pain relief, your doctor will want you to understand there’s no evidence for the effectiveness of these medicines for chronic primary pain.
So your doctor may suggest you agree a shared plan for continuing your medicines safely if you think you benefit from them at a safe dose with few harms.
Alternatively your doctor might encourage and support you to reduce and stop the medicine, if possible.