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CPD module: Chronic primary pain

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Learning objectives

After completing this module, you should be more aware of:

·       The distinction between chronic pain and chronic primary pain, and primary pain and secondary pain

·       NICE recommendations on managing chronic pain, both in the new draft guideline and in existing guidelines

·       Non-drug and drug options for managing chronic primary pain

·       Recommendations on antidepressant use and avoiding established analgesics for chronic primary pain

·       Advice on how the new draft NICE guideline for chronic pain should be considered alongside wider recommendations for pain management

·       Other NICE guidance on prescribing for pain.

·       Guidance about stepping up pain relief

·       Principles of analgesic use in mild to moderate pain

New NICE guidance on pain management created headlines – and possible confusion – in August. This stemmed from a press release headed: “Commonly used treatments for chronic pain can do more harm than good and should not be used, says NICE in draft guidance.”1

It was only made clear further into the press release, which announced the publication of the draft guideline ‘Chronic pain in over 16s: assessment and management’, that this recommendation applied to ‘chronic primary pain’. This is a sub-category of ‘chronic pain’ that was only formally defined in 2019.2,3

NICE explained: “Chronic primary pain represents chronic pain as a condition in itself and which can’t be accounted for by another diagnosis, or where it is not the symptom of an underlying condition (this is known as chronic secondary pain).1

“It is characterised by significant emotional distress and functional disability. Examples include chronic widespread pain and chronic musculoskeletal pain, as well as conditions such as chronic pelvic pain.”

The draft guideline was out for consultation until mid-September, but the final version is not expected until January 2021. It should be used alongside existing NICE clinical guidelines for specific conditions that cause pain (acute or chronic), and for which analgesic are still recommended. Analgesic recommendations also remain in less formal NICE guidance, such as Clinical Knowledge Summaries (CKS) and Key Therapeutic Topics (KTTs).4



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