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NICE, who set the clinical standards for treatment in the UK, just released their draft guidelines on treatment of chronic pain.
It basically rules out all painkillers, from NSAIDs to Opiods, along with almost every other treatment modality except for talking therapies, exercise, and acupuncture - and only if they're less than 5 hours and delivered by a junior healthcare worker - nurse-practitioner/specialist physio or under. The only drugs permitted are a limited number of anti-depressants. Even the gabapentinoids, which were previously considered a wonder drug for being effective on neuro pain and not opioids, are banned, with apparently the sole justification that they're abused by other people. Even TENS machines are banned.
The guidelines are supposed to be evidence based, but most of the 'evidence' seems to be 'we don't have any evidence'.
It's supposed to only apply to chronic primary pain, which is where there is no direct cause, rather than chronic secondary pain where there is, but my experience is even specialist pain management professionals have difficult distinguishing between the two, so you've got no hope of GPs managing it, and given the time to diagnosis in the case of some of the pain-causing disabilities is significantly over a decade there are going to be tons of people caught in a situation where they are wrongly considered to be in the primary pain group.
I'm going to have to dig into the diagnoses, because AFAICS, neuroplastic remodelling, where the nervous system rewires itself to be hair-triggered to pain, is likely to fall into chronic primary pain, and only way you're going to get talking therapies to affect that is magical thinking, which is a psychological condition, not a psychological treatment.
To make matters worse it was initially announced as having a public consultation period running from today until the 14th, which is completely inadequate when they have 2686 pages of documentation. Actually more than 2686 as there's an 'economic justification' you have to sign an NDA to see. They quietly changed it to 14th September after I started banging on about it on their social media and linking in disability journos. I hope it was an error, but I wouldn't guarantee it. And no idea how I'm supposed to respond to a public consultation over something I have to sign an NDA to see.
Grrr....
