In new guidelines published by NICE on 7th April, those suffering with chronic primary pain (pain for which there is no diagnosed cause) will now be offered treatments ranging from exercise, psychological therapy, and acupuncture. The guidance is clear — do not give painkillers, local anesthetics, or anti-inflammatory drugs.
This has rightly caused outrage, with The British Pain Society raising concerns around doctors now withdrawing access to painkillers, and leaving many in severe, unmanaged pain. These new guidelines entirely disregard the benefits of painkillers, which allow so many people to continue on with daily life despite their debilitating chronic pain.
It is not well known that between one-third and one-half of the UK population suffer from chronic pain, according to a 2016 review. Most people simply do their best to hide it, manage it, and get on with their normal lives. Chronic pain conditions are notoriously hard to diagnose, and those of us who have them suffer immense stigma, anxiety and are often labeled ‘hypochondriacs’ by medical professionals. We are told the pain is ‘all in our heads’, that pain is simply a part of life, that we are just more sensitive to pain than others. For this reason, many chronic conditions go undiagnosed for a number of years.
This is why the new NICE guidelines are so demeaning. Offering CBT, antidepressants, and encouraging physical activity simply reaffirms the very worst fear of the patient — that their pain is psychological, imagined, psychosomatic. This approach lacks not only compassion but an understanding of the symptoms of chronic pain conditions. In the case of arthritis, fibromyalgia, and chronic fatigue syndrome, physical activity is not only incredibly difficult but can also cause flare-ups of pain, which can last for as long as months. Fibromyalgia takes five years on average to diagnose. Whilst waiting for a diagnosis, patients will be encouraged to increase physical exercise, most likely putting them off pushing forward with their diagnosis, as their pain has been repeatedly devalued and misunderstood.
The new guidelines also lack consideration of the effect which the Covid-19 pandemic has had on access to healthcare. The process of getting a diagnosis, which is already arduous and exhausting, is now even more difficult. With GPs and consultants less easy to get hold of, and a general feeling of not wishing to be a ‘burden’ on the NHS, 1% to 6% of the population in England are currently living with undiagnosed chronic pain, the Guardian says.
The introduction of these guidelines is not all too surprising if you are a sufferer of primary or secondary chronic pain. There is an immense stigma around pain, especially pain with no known cause. To be in pain and experience this stigma is an isolating experience, which can lead to anxiety, depression, and suicidal thoughts. Painkillers are not a long-term solution. However, for so many, they ease pain long enough for the individual to enjoy the everyday in a way they simply could not without pain relief. Antidepressants can be effective when combined in a treatment plan, but what is the point of prescribing these if doctors are not attempting to tackle the root cause of the anxiety and depression in the first place?
In my view, these guidelines lack the human compassion and respect necessary to effectively support those suffering from chronic primary pain. Relief from pain is often trial and error, and I believe that the best methods to achieve this should be left up to the individual — judgment over which methods the patient chooses to use is unacceptable. Consideration must be afforded to how difficult pain conditions are to diagnose, and how long patients are on NHS waiting lists to see a specialist.
Instead of adopting a condescending attitude towards chronic primary pain sufferers, let’s focus on empowering them to choose their own methods of pain relief, free of judgment, and free of shame. Validate the patient’s pain and the adverse effect this pain is having on every aspect of their life. Chronic pain, primary or secondary, is real and debilitating. The pain is not ‘all in our heads’.
Photograph: Obi Onyeador via Unsplash