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Chronic pain should be treated with acupuncture rather than opiates, new guidance suggests

Acupuncture should be used to treat chronic pain rather than opiates, according to new guidance for GPs and sufferers. - Getty 
Acupuncture should be used to treat chronic pain rather than opiates, according to new guidance for GPs and sufferers. - Getty

Acupuncture should be used to treat chronic pain rather than opiates, according to new guidance for GPs and sufferers.

The draft guidelines, released today by NICE (National Institute of Health and Care Excellence), states that commonly used drug treatments for chronic pain have “little or no evidence that they work”.

Instead, physical exercise, psychological therapy, antidepressants or acupuncture, should be offered to patients, it says.

Chronic primary pain is a condition which cannot be attributed to another diagnosis and is often characterised by significant emotional distress, such as anxiety or depression, as well as causing disability in daily life tasks.

It is estimated to affect between one third and one half of the population.

The new NICE guidance, which is open for public consultation until September 14, recommends that some antidepressants should be considered as treatment, after a review of evidence found they “improved quality of life, pain and psychological distress compared with placebo”.

But the committee ruled against the recommendation of pain management drugs, such as paracetamol, non-steroidal anti-inflammatory drugs (these include aspirin and ibuprofen), benzodiazepines and opioids.

“The lack of evidence for effectiveness of opioids, along with evidence of long-term harm, persuaded the committee to recommend against opioid use for people with chronic primary pain,” the guidance says.

It comes as health experts recently warned opioid painkillers do not work for nine in 10 people with chronic pain.

The guidelines also advise against antiepileptic drugs, such as local anaesthetics and ketamine, as there was also little or no evidence that they work, but they could cause harm.

Instead, treatments such as a group exercise programme or cognitive behavioural therapy (CBT) are recommended.

The committee also said “a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system” should be considered to treat chronic primary pain.

But only if it is delivered within a community setting by a health care professional.

Explaining the rationale for its recommendation the committee said 27 studies have shown acupuncture reduced pain and improved quality of life in as little as three months, “compared with usual care or sham acupuncture”.

But it added there is not enough evidence to assess its long term effectiveness.

The guidance went on to add: “The committee acknowledged the difficulty in blinding for sham procedures, but agreed that the benefit compared with a sham procedure indicated a specific treatment effect of acupuncture.”

Paul Chrisp, director of the Centre for Guidelines at NICE, said the guidance highlights the importance of communication when it comes to caring for those 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,” he said.

Nick Kosky, a consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust and chair of the guideline committee, said a contrast between patient expectations and treatment outcomes can impact their relationship with doctors.

“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,” he said.

“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 new guidance will help to improve this relationship, Dr Kosky said, by “fostering a clearer understanding of the evidence for the effectiveness of chronic pain treatments”.