NICE guideline for chronic pain: painkillers out, acupuncture in

The National Institute for Health and Care Excellence (NICE) is set to endorse acupuncture as one of only four treatment options GPs can consider prescribing for people with chronic pain conditions. From January 2021, painkillers and all other drugs, apart from anti-depressants, will be off the prescription pad menu.

This new guideline is for chronic primary pain, characterised by emotional distress and functional disability. Common conditions that would qualify are fibromyalgia, myofascial pain, chronic neck pain and chronic pelvic pain, though there are many more possibilities.

This is NICE’s first guideline for chronic pain in general, rather than a specific painful condition, though the equivalent Scottish guideline agency (SIGN) has had one for several years (and it, too, endorses acupuncture).

Which treatments are recommended by NICE in this guideline?

acupuncture

exercise: a supervised group programme, preferably followed up long-term by patients themselves

psychological therapies: specifically cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT)

antidepressant drugs

Ten other classes of medication were considered and rejected by NICE. These included opioids, anti-inflammatories, paracetamol, benzodiazepines and gabapentinoids: none of these were found to have evidence of benefit for chronic pain and there are possible harms associated with their use.

Research shows that acupuncture is one of the best options for chronic pain, and it’s great that NICE recognise what so many patients know from their own experience of treatment.

One of the drivers behind the NICE decision is the urgent need to cut down prescriptions of opioids and other painkillers. In the United States – where opioid addiction is having a devastating impact – acupuncture is an increasingly popular option, supported insurance companies, and for example, a mainstream treatment on offer in healthcare services for US forces veterans .

Acupuncture isn’t only effective for pain, also one of the safest forms of treatment there is, when given by highly trained practitioners. I’m trained to the exacting and stringent standards of the British Acupuncture Council (BAcC). (That’s the membership body I belong to). The BAcC is registered with the Professional Standards Authority (PSA), and although it’s not quite clear yet just how referrals will work once the guidelines are adopted, because we are registered with the PSA, GPs should be able to refer their patients to BAcC members like me for acupuncture for chronic pain (as long as NHS funding allows.)

It is important to realise that this guideline for GPs excludes any condition whose pain management is addressed by existing NICE guidance, that is headaches, low back pain, sciatica, osteoarthritis, rheumatoid arthritis, spondyloarthritis, endometriosis, and IBS. But have a look at the research on how acupuncture can help with these conditions too.