Patients with chronic pain should not turn to analgesics to alleviate their discomfort, a health official said.
The National Institute for Health and Care Excellence (Nice), which offers guidance for the NHS, emphasizes that prescription drugs such as paracetamol, aspirin and opioids are commonly prescribed “with little or no evidence that they do. “.
Treatments can do “more harm than good” if a patient develops an addiction, it warns.
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Nearly six million people in England and Wales were prescribed opioids in 2019, twice as many as 20 years ago. While the UK situation is somewhat more severe than US addiction, the death toll is rising.
Nice patients should be instead prescribed exercise, psychological therapy or acupuncture.
‘Little to no evidence’ are common painkillers that alleviate discomfort
Chronic pain, be it a recurrent headache or discomfort in the back, affected between 13% and 50% of Britons in 2019.
While the disease is a spectrum, 10.4% to 14.3% are experienced or severe.
The NHS recommends a combination of exercise, physical therapy and painkillers to alleviate debilitating symptoms.
Over-the-counter analgesics include paracetamol or the anti-inflammatory drug ibuprofen.
In more severe cases, amitriptyline or gabapentin may be prescribed for pain caused by sensitivity or nerve damage, such as shingles or sciatica.
The strongest painkillers available are morphine or similar action drugs, such as opioids.
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In its new report Chronic pain: assessment and management, Nice warns “a number of commonly used drug treatments for chronic underlying disease are little or no evidence that they work and should not be prescribed”.
Chronic primary disease is a condition in itself, rather than occurring as a symptom of another diagnosis.
The report states that the antidepressant may relieve discomfort in some cases.
It adds paracetamol, non-steroidal anti-inflammatory drugs – such as aspirin and ibuprofen, benzodiazepines – “benzos”, and opioids should not be given, however.
“This is because, with little or no evidence that they make any difference in the quality of human life, illness or psychological distress, there is evidence that they can cause harm, including possible addiction,” the team wrote in back of the report.
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Opioids are often associated with addiction, with many abusers experiencing euphoria, followed by withdrawal symptoms.
Misuse can lead to respiratory distress, when the lungs do not alter the efficient exchange of carbon dioxide and oxygen.
An increasing number of deaths in the UK mention an opioid bait drug in the death certificate. The drug tramadol is specifically behind nearly 240 deaths a year.
In the US, more than 67,000 people died from overdose in 2018, of which nearly 70% were involved in a prescription or silent opioid.
Unlike in the US, the UK-funded health care system means patients cannot go from doctor to doctor requesting treatment, experts said in a Science Media Center briefing on January.
Britons also have access to opioid replacement treatment, they added.
Patients prescribe ‘ineffective but harmful drugs’
Opioids besides, Nice stressed chronic-pain patients should also not be offered local anesthetics, ketamine, corticosteroids or antipsychotics.
“Again, this is because there is little or no evidence that these treatments work but there may be possible harm,” the team wrote.
They recommend acupuncture for some patients, “provided it is delivered within certain, clearly defined parameters”.
The insertion of needles into problem areas is said to stimulate the felt nerves under the skin and in the muscles, triggering the release of pain-relieving pain.
Nice recommends acupuncture for chronic pain in the form of tension or migraines. There is also evidence that it can alleviate joint, dental or post-operative pain.
Acupuncture is sometimes available on the NHS, however, most are private.
Nice’s report – which is in a draft phase – emphasizes patients should be at the center of their care, with a supporting relationship nurtured between the individual and health care professionals.
“What this draft guide highlights is the fundamental importance of good communication in the care experience of people with chronic illness,” said Paul Chrisp from Nice.
“If many treatments are ineffective or not well tolerated, it is important to gain an understanding of how the disease affects a person’s life and those around them because knowing what is important to the person is the first steps in developing an effective care plan.
“It is important that the draft guide recognizes the need for further research across the full range of possible treatment options, reflecting both the lack of evidence in this area and the need to provide additional options for people with the condition.”
Dr Nick Kosky – a consultant psychiatrist at the Dorset HealthCare NHS University Foundation Trust and chairman of the committee under Nice’s guidance – added that “there is no ambiguity between patient expectations and treatment outcomes” could affect the relationship between a professional in health care and patients.
As a “consequence”, patients may be prescribed “ineffective but harmful drugs”.
“This guide, by cultivating a clearer understanding of the evidence for the effectiveness of chronic disease treatment, will help to improve the confidence of health care professionals in their endeavors. talk to patients. In doing so it will help them better manage themselves and their patient expectations, “added Dr Kosky.