NICE Recommends Antidepressants Not Painkillers for Chronic Pain

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From BBC News: “Doctors are being advised not to prescribe common painkillers, including paracetamol and ibuprofen, for patients with chronic pain not caused by an injury or other medical condition.

The National Institute of Health and Care Excellence (NICE) said there was little evidence they help. And it suggests there is evidence long-term use can be harmful.

Its draft guidance recommends antidepressants, acupuncture or psychological therapy instead.

The advisory body also strongly advises against the use of opioids for these patients, in a set of guidelines covering England, Wales and Northern Ireland. It said there was a ‘lack of evidence’ for the effectiveness of opioids for this condition, along with a risk of long-term harm.

Chronic primary pain is defined within the guidelines as a condition which ‘can’t be accounted for by another diagnosis’. This type of unexplained pain may affect as many as between a third and half of people in the UK, the guidelines estimate.”

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18 COMMENTS

  2. “Its draft guidance recommends antidepressants, acupuncture or psychological therapy instead.”

    “This marked a ‘stark move from pharmacological therapies to alternative therapies,’ according to the Royal College of GPs.”

    The first new recommendation is a pharmacological therapy. And the antidepressants are much more dangerous than the common painkillers, including paracetamol (acetaminophen) and ibuprofen.

    It strikes me that maybe the government public health officials should get out of the business of dictating what doctors do, or don’t do. And instead encourage the doctors to get to know their patients, and make treatment recommendations, on a case to case basis.

    After all, it’s long been known in medical circles that, “It’s far more important to know what person the disease has than what disease the person has.” And, of course, these public health officials don’t know anything about any of the patients.

    But I can tell you that prescribing antidepressants for pain is about as stupid as mandating all healthy people wear masks.

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    • You noticed the AD’s mentioned first SE. And of course we know that acupuncture was thrown in there to make it seems that AD’s are a “natural” course of treatment. Duh how progressive of them.

      if you want to be “treated” properly, you have to be a doctor, or lawyer. It’s insurance. It is actually doctors that demanded to be left alone to do their jobs, without interference or lawsuits.

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  3. From the article: “Both medicines [ibuprofen and paracetamol] came with the risk of possible harm, including stomach and liver damage.”

    And antidepressants are some magic pills that have no side effects what-so-ever?

    I have chronic neck and back pain. Not terrible, but to the point where things can become difficult. I’m on two antidepressants (Paxil and Anafranil) and they’ve done jack shit for my pain. And I can’t somehow think myself out of that pain, either because it’s not in my mind. It’s in my body.

    You want to know what works for my pain? Ibuprofen. And, on the rare occasion, a prescription muscle relaxer like Flexeril. TENS therapy also works. So does a heating pad.

    Don’t get me wrong, I think opioids should be avoided unless someone has exhausted other options. But for people with severe chronic pain, their pain is still real and needs management. There *are* people out there who have such severe chronic pain that they need to use opioids. I haven’t met any kind of chronically ill person who *wants* to be on the medication they’re on.

    But don’t go prescribing antidepressants like candy. They may not be as potent as opioids, but they come with their own sets of side effects and lack of long term studies.

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  5. There is certainly nothing wrong with private enterprise starting up business. I think a lot of “care” will go underground. Doctors cannot get themselves to say that they never had the answer on how to fix physical ailments. They know squat scientifically and relied on Pharma. All this move is, is a crackdown on opioids.

    Why not a crackdown on AD’s? Headaches and endometriosis eh? Sounds like women’s issues, or do men get endometriosis?
    I guess they all had a meeting without the public vote. It is high time for nothing less than a revolution.

    No one cares if doc’s admit they cannot help because they lack knowledge, however people are tired of the lies.
    That would be the reason other options are asked for. For generations people had nothing for pain. Then along came pharma. They failed…..yet docs want “some” of big pharma drugs. The ones that they can defame a patient. They should be ashamed to practice at all. Go back to the old days, but with honesty.

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    • Yes, Sam. So many people want to delude themselves that the people involved in the manufacture and prescribing of psych drugs have more honest intentions than the people who were involved in the manufacture and prescribing of the opiates that caused the epidemic. They’re the same people. Pharmaceutical companies and doctors. And in both cases the FDA lets it happen. And in both cases the victims are the patients who wind up incarcerated in psych wards or in the case of opiate addicts, in prison. We get treated as criminals. The pharmaceutical companies and the doctors are the real criminals.

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  6. Cymbalta is poison. I don’t know if I’ll ever be “right” since coming off it. I still have terrible tinnitus, profuse sweating, and serious problems with agitation/irritability/paranoia. The GP who recommended it to me gave me no warning of the dangers (she just said, “you have pain. Cymbalta is great for pain”), and because I’ve been denied actual medical help for everything from a fractured ankle to severe arthritis and degeneration in my neck to hip bursitis while they chalk my pain up to fibromyalgia (i.e. they see me as drug seeker/hypochondriac), I broke down and started taking it. My body is so broken from the ECT and all the drugs they’ve thrown at me and told me I needed from the time I was 17. I’m 54 now and the Cymbalta withdrawal on top of other additional trauma I’ve been through the past couple of years while being denied any form of medical help, changed my entire personality and outlook on life. I see the world as a very dangerous place and life as an endless nightmare. I used to have a light in me but it’s gone now.

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  10. “Nick Kosky, a consultant psychiatrist at Dorset HealthCare NHS University Foundation Trust 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.”

    Ofcourse it’s a psychiatrist. What else can we say – oh yes, it was psychiatrists who started the opiod pain relief addiction death epidemic in the first place: Purdue Pharma. All three Sackler brothers were psychiatrists. You know what – I rather suspect they have seen the litigation against Purdue Pharma.

    “Suicides will rise.” Yes and they will do what they have been successful at doing and put it down to “mental illness” or should I say get away with it by using “mental illness”. So ofcourse it’s about helping themselves out if litigation and into a new market as usual. So long as the market may involve depression as an excuse such as pain and say skin complaints such as psoriasis, when people kill themselves it’s “mental illness” depression causing suicide thoughts due to the patients condition.

    Our job is to inform the general public about drugs causing Akathisia and ghost written papers of the trial data that no one see’s unless a US court allows it.

    For those new to this snake pit of vipers called ‘health care’ and the monster called psychiatry look up Study 329.

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