Among existing NICE pain guidance is Key Therapeutic Topic [KTT21] ‘Medicines optimisation in chronic pain’ from 2017. This was last updated in September 2019 but does not refer to chronic primary pain.22

However, it notes: “Although analgesics can sometimes work effectively to relieve chronic pain, this is only achieved in a small percentage of people: it is unusual for any analgesic, including strong analgesics like opioids, to completely eliminate chronic pain. So, the focus of treatment should be on reducing a person's pain with a view to improving their quality of life.”

In addition, non-pharmacological interventions may be effective in reducing symptoms and disability in some cases, and may augment and complement analgesic use.

NICE is also developing a guideline on safe prescribing and withdrawal management of prescribed drugs associated with dependence and withdrawal (opioids, antidepressants, gabapentinoids, benzodiazepines, and Z-drugs), which is expected in November 2021.23