Sorry About Your Pain But...

[davebro]

Doctors are being told to stop prescribing most painkillers for chronic primary pain. Instead they may offer antidepressants. So if you are depressed because you have chronic pain then instead of possibly becoming addicted to opioids you may possibly become addicted to antidepressants. You will still have chronic pain but hey - guess what - you will happy about it!

Anyone think this advice has been dreamed up by someone who doesn't suffer chronic pain?

https://www.expressandstar.com/news/uk-news/2020/08/03/painkillers-like-paracetamol-should-not-be-prescribed-for-chronic-pain-nice/

[wolf63]

I am sure that someone more knowledgeable than me will come along but I do know ...

Anti-depressants can help with pain - I don't understand the chemical reasons for this but it is a legit treatment.

You can't get addicted to antidepressants, they can be lifesavers but they are not addictive.

[Mamyalynne]

Antidepressants can help in pain management and are already widely used - however they don't always help with joints and mobility issues, so it rather depends on what the mechanical reasons are for your pain.

[Tilly2]

Someone needs to break this to Sqad!

[woofgang]

If you read the actual article it makes good sense. When I worked in the community it was not unusual to find people struggling with chronic pain who had never had proper investigation, with shedloads of analgesia which they didn't take because it didn't work or didn't agree with them or both. The usual comment was "when I go to the doctor he doesn't listen he just gives me more pills." This reccomendation is only for people who suffer with chronic PRIMARY pain ie " a condition in itself which cannot be accounted for by another diagnosis or as a symptom of an underlying condition.
It is characterised by significant emotional distress and functional disability with examples including chronic widespread pain and chronic musculoskeletal pain."

It used to be called "idopathic pain"

[david small]

If my wife stopped taking pain killers it would be way too much for her to cope with.

[rowanwitch]

In the pain clinic where I worked (part of the day surgery unit). The consultant had a number of patients who took painkillers for 'fear of pain'. The original issue had been resolved but anxiety and tension resulted in guarding, stiffness and because these cause aches they took more painkillers. Headache sufferers who develop paracetamol rebound headaches, worse than the original cause, and other reasons. Treating anxiety was often effective, as was acupuncture for a number of them. Physio and exercise if you could convince patients was so often the way forward.

[Buenchico]

I'm sorry to appear pedantic but the new advice relates solely to 'chronic primary pain' and not just to 'chronic pain' (as in Davebro's post).

'Chronic primary pain' is recognised as a disease in its own right by the latest edition of the International Classification of Diseases (ICD-11), being characterised by significant emotional distress and functional disability and where the pain isn't a symptom of another condition.

Chronic primary pain is totally separate to chronic secondary pain (where the pain is a symptom of, say, cancer), which the new guidance does NOT relate to.

Specialist NHS pain clinics already use psychological therapies, alongside things like exercise regimes, to help people cope with long-term pain ( https://www.nhs.uk/live-well/healthy-body/how-to-get-nhs-help-for-your-pain ), so the new guidance from NICE is only building upon what already exists and is known to work.

[jourdain2]

Mmmm. I used to have weekly physio in France, which solved my back pain in-so-far that I could carry on normally. When I came to UK and eventually asked my GP I was referred for 6 weeks to a physio who saw me in a gym, NEVER laid hands on me, ensured I could manage the exercises she gave me and told me that the object was to enable me to 'manage the pain'.

In France the message was 'Pain is unnecessary - we can do something about it' (in print, in brochures) and sessions involved a heat lamp, massage and manipulation as well as exercises.

I don't want the upheaval of moving back to France - but the treatment we have received from the NHS has been abysmal (individual practitioners exempted - most have been wonderful and caring) because expectations are low I think. We are seriously considering it, but I really don't want to go and we've paid all our lives into the NHS. We know 2 couples who have already returned to France because of the total inadequacy of the NHS and another dear friend is very seriously considering it.

Anyone who has suffered chronic pain will know better, surely than to recommend anti-depressants. 'Grin your way to death or paralysis, people, we can make you happy about it' ...... or words to that effect .... and that was before Covid and mass discharge of patients to shorten the waiting-lists!

[woofgang]

You are missing the point folks. As Buenchico and I have said this is about one condition called CHRONIC PRIMARY PAIN which used to be called IDIOPATHIC PAIN. idiopathic means "we don't know what is causing it". This is not pain from something that can be identified like arthritis, prolapsed disc, frozen joint, crumbling bone and so on. Please read the link (maybe also the thread!) before you rush to comment!

[Peter Pedant]

// Someone needs to break this to Sqad!//

erm well I think that this has been really badly reported by the Beeb fluffy journos and their cohorts. as noted above - it is made clear that this is chronic pain
and that it is OK for acute short term pain

and to a certain extent NICE are right
they dont work very well in chronic pain
and addiction is an issue ( much more in America and much more about Oxycontin )

and I am not surprised people have got the wrong end of the stick - it has been really badly reported

[Peter Pedant]

yeah thx woofie
it is in the report
but one cannot blame the average ABer swallowing whole, the blandishments of the sirens of the Beeb

[considering what they are exposed to on a daily basis]

[woofgang]

PP can i wiggle in a correction here? Its not "chronic pain" ie pain that goes on and on.....its chronic PRIMARY pain ie " a condition in itself which cannot be accounted for by another diagnosis or as a symptom of an underlying condition.
It is characterised by significant emotional distress and functional disability with examples including chronic widespread pain and chronic musculoskeletal pain."

There are many conditions that have chronic pain as a component and which can be helped by various forms of analgesia. This is not that.

[Buenchico]

Many people, regrettably, don't read beyond the headlines, so our sensationalist media do little to promote genuine understanding:
https://www.tomorrowspapers.co.uk/daily-express-front-page-2020-08-04/

[bednobs]

Jourdain if you have lived abroad you have not paid into the nhs all your life. NHS is funded by current tax payers. Unless you were living abroad but paying tax here you will not have paid in all your life

[woofgang]

Indeed Chris

[woofgang]

getting back to the subject, its a great pity that it is amytriptaline that works. I have known people get very upset because "The doctor thinks its all in my head" and "I am not crazy"

[wolf63]

I was prescribed anti-epileptic drugs for Manic Depression.

[ummmm]

And I'm on beta blockers even though I don't have a heart condition or suffer anxiety and have low blood pressure. Drugs often have more than one use.

[Buenchico]

^^^ Agreed. I'm using women's HRT patches to treat prostate cancer!

[jno]

the Express front page is fine. You can't cram everything into a headline, the idea is to get those interested to read the story: in the Express they would have got the full explanation of chronic primary pain in the second paragraph.

The Times on the other hand did it really badly

https://www.tomorrowspapers.co.uk/times-front-page-2020-08-04/