The draft guideline has much more to say about approaches to managing chronic primary pain. Recommendations about non-pharmacological interventions include:2

·       Exercise should be encouraged – possibly as a group exercise programme but tailored to specific patient needs and the nature of the chronic primary pain

·       Acceptance and commitment therapy (ACT) or cognitive-behavioural therapy (CBT), but not biofeedback, can be considered for chronic primary pain in those aged 16 and over

·       Acupuncture is appropriate in the community setting, providing it lasts no longer than 5 hours in total and is delivered by a band 7 (or lower) healthcare professional

·       Electrical physical modalities for pain should not be offered – this includes TENS machines, ultrasound and interferential therapy (low-frequency electrical current nerve stimulation)

·       As there is insufficient evidence for manual therapy, more research is required.

When analysing the role of pharmacological interventions for chronic primary pain, NICE says many factors need to be considered. “When prescribing for pain it is important to reflect on not only the neurobiological rationale for their use but also the emotional, cultural and social determinants and personal consequences of the pain experience that can shape the likely response to medicines that have specific molecular targets in pain processing systems.”20