NICE guideline for chronic pain: painkillers out, acupuncture in

The National Institute for Health and Care Excellence (NICE) has published a new guideline for chronic pain. This guideline was driven by the urgent need to cut down prescriptions of opioids and other painkillers and includes acupuncture as one of the four recommended treatments.

This is NICE’s first guideline for chronic pain in general, rather than a specific painful condition, and the implications of these recommendations are enormous for UK healthcare policy and allocation of resources.

Around a third of the population may be affected by chronic pain; many of those also have a diagnosis of depression, and it is a major contributor to absence from work.

Pain management in this new guideline is focused on chronic primary pain, i.e. there is no underlying condition that adequately accounts for the pain or its impact. It is often accompanied by significant emotional distress and functional disability.

Common conditions that would qualify are fibromyalgia, myofascial pain (i.e. in the muscles and surrounding connective tissue), chronic neck pain and chronic pelvic pain, as well as many others.

Acupuncture (within a traditional Chinese or a western framework) is recommended alongside; exercise programs, psychological therapies and antidepressant drugs.

NICE considered a number of treatments in creating this guideline including opioids, anti-inflammatories, paracetamol, benzodiazepines and gabapentinoids. None of these were found to have evidence of benefit for chronic pain and there are possible harms associated with their use. Acupuncture was found to be superior to both sham and usual care for pain according to the 32 studies reviewed by NICE.

Two existing studies, and a further analysis by NICE, showed that acupuncture was cost-effective within a NHS framework.

This new guideline is a significant development for both patients with chronic pain and acupuncture practitioners in the UK. BAcC accredited acupuncturists are particularly well qualified for treating the wide spectrum of symptoms seen in patients with chronic primary pain conditions due to their degree level training and wide scope of practice.

To learn more about the guideline, click here: