In August 2020, the National Institute for Health and Care Excellence (NICE) published the draft guidance on chronic pain, which perhaps controversially advises against the use of all drugs except antidepressants.1 The committee cite an absence of evidence on effectiveness, their experience, information in product summaries, and the established or possible risk of harm as justification for their negative recommendations. Public reaction perhaps reflects the assumption the guidelines apply to all chronic pain conditions. This is not the case. The guideline explicitly does not cover pain conditions that have existing NICE guidelines including headache, low back pain (LBP) and irritable bowel syndrome (IBS).1–6 This creates an interesting tension, since some recommendations are discordant (Box 1).
|Drug class盘他s直播app在线下载盘他s直播app在线下载,七仙女下凡的故事150字七仙女下凡的故事150字,屁股冷疼是什么原因导致的屁股冷疼是什么原因导致的||Draft NICE guideline: chronic pain in over 16s, August 20201||NICE guideline: low back pain and sciatica in over 16s, updated September 20205||NICE guideline: headache in over 12s, updated November 20154,a||NICE guideline: irritable bowel syndrome in adults, updated April 20176||NICE guideline: osteoarthritis, updated February 20148|
|Opioids||Do not offer||Do not offer||Be alert to the possibility of medication overuse headache in people whose headache developed or worsened while they were taking the following drugs for ≥3 months:
||No specific recommendation||If paracetamol or topical NSAIDs are insufficient consider the addition of opioid analgesics|
|NSAIDs||Do not offer||Consider oral NSAIDs (conditions apply)||No specific recommendation||Where paracetamol or topical NSAIDs are ineffective consider substitution with (or addition of) an oral NSAID/COX-2 inhibitor|
|Paracetamol (acetaminophen)||Do not offer||Do not offer paracetamol alone||No specific recommendation||Consider offering paracetamol in addition to core treatments.|
|Antidepressants||Consider an antidepressant, either duloxetine, fluoxetine, paroxetine, citalopram, sertraline, or amitriptyline||Do not offer SSRIs, serotonin–norepinephrine reuptake inhibitors, or tricyclic antidepressants||Consider amitriptyline for the prophylactic treatment of migraine||Consider TCAs as second line treatment for people with IBS. Consider SSRIs for people with IBS only if TCAs are ineffective||No specific recommendation|
|Anticonvulsants||Do not offer||Do not offer||Do not offer gabapentin for prophylactic management of migraine||No specific recommendation||No specific recommendation|
↵a The guidance for headache is not specific to chronic headache pain. NSAIDs and paracetamol are recommended for acute treatment of tension headache and migraine with or without aura. IBS = iritable bowel syndrome. NICE = National Institute for Health and Care Excellence. NSAID = non-steroidal anti-inflammatory drug. SSRI = selective serotonin reuptake inhibitor. TCA = tricyclic antidepressants.
The guideline committee used the International Classification …
Members, please Login at RCGP to access the journal online.
盘他s直播app在线下载盘他s直播app在线下载,七仙女下凡的故事150字七仙女下凡的故事150字,屁股冷疼是什么原因导致的屁股冷疼是什么原因导致的 Subscriber login
Enter your BJGP login information below.