Petition Commission NICE to Review Guidelines on Chronic Pain (Published April 2021)

The Government has no plans to commission the National Institute for Health and Care Excellence (NICE) to review the guideline on chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain [NG193]. (https://www.nice.org.uk/guidance/ng193)

NICE is an independent body that develops authoritative, evidence-based guidance on best practice for the NHS. NICE guidelines are developed independently by experts based on the available evidence and consultation with stakeholders, and the Government cannot formally commission NICE to review guidelines.

The guideline recommends that people with chronic primary pain should not be started on commonly used drugs including paracetamol, non-steroidal anti-inflammatory drugs, benzodiazepines or opioids. This is because NICE have determined there is little or no evidence that they make any difference to people’s quality of life, pain or psychological distress, but they can cause harm, including possible addiction.

Instead, the guideline recommends a number of interventions that have been shown to be effective in managing chronic primary pain, such as acupuncture, exercise programmes and psychological therapies. Furthermore, the guideline recommends that an antidepressant can be considered for people aged 18 years and over to manage chronic primary pain, after a full discussion of the benefits and harms. This is because NICE have determined the evidence shows antidepressants may help with quality of life, pain, sleep and psychological distress, even in the absence of a diagnosis of depression.

The recommendations represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service.

NICE has made it clear that medicines should not be withdrawn from patients if they are safe and effective for them, and recommend that clinicians discuss the risks and benefits of medication with the person with chronic primary pain, emphasising the importance of putting patients at the centre of their care, of shared decision making and of fostering a collaborative, supportive relationship between patients and healthcare professionals.

Whilst NICE guidelines are not mandatory, the Government would expect patients presenting with symptoms consistent with chronic long term pain conditions to be managed according to clinical need and in line with all current guidance. NICE continues to work with system partners to support them to implement the updated guidelines.

The Government is committed to supporting people living with chronic pain and acknowledges that individuals will need a tailored approach to manage their condition. The majority of services for people with chronic pain conditions are commissioned locally by Integrated Care Systems, who have a statutory responsibility to provide a comprehensive health service to their local populations subject to local prioritisation and funding.

Although much of the routine care people with chronic pain receive will be provided by local primary, community and secondary care services via Integrated Care Systems, NHS England commissions specialised care for patients whose pain cannot be successfully controlled or is particularly complex to manage. Upon referral to specialist centres, patients can access a range of health professionals, including consultant specialists, clinical nurse specialists, psychologists, physiotherapists and receive specialised treatment.

NHS England commissions these specialised pain services nationally, and has set out what specialist providers must have in place to offer this specialist service in its service specification: https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-d/d07/.

To improve outcomes for those living with chronic pain, NHS England have established a task and finish group to produce guidance on the provision of high-quality services for people with long-term pain conditions by September 2022. The guidance is aimed at Integrated Care Systems, to provide core principles which can be used to inform the development of local models of care to support people living with chronic pain.

Earlier this year, NHS England also appointed Professor Tony Avery OBE as the first National Clinical Director for Prescribing. The work of the newly established role will focus on recognising the vital role that medicines have in treating illness and helping people live with long-term conditions, including chronic pain conditions, whilst ensuring their safe, effective and appropriate use, and that health care professionals and patients have the information and support they need for shared decision making about whether a prescription is needed.

Department of Health and Social Care