Painkillers such as aspirin 'do more harm than good' for chronic pain

[Northerner]

Painkillers such as paracetamol, ibuprofen, aspirin and opioids can do “more harm than good” and should not be prescribed to treat chronic pain, health officials have said.

The National Institute for Health and Care Excellence (Nice) said there was “little or no evidence” the commonly used drugs for chronic primary pain made any difference to people’s quality of life, pain or psychological distress.

But the draft guidance, published on Monday, said there was evidence they can cause harm, including addiction.

The chairman of the guidance committee, Nick Kosky, said that, while patients expected a clear diagnosis and effective treatment, the complexity of the condition means GPs and specialists can find it very “challenging” to manage.

Painkillers such as aspirin 'do more harm than good' for chronic primary pain

NHS health officials say paracetamol, ibuprofen and opioids also unsuitable for chronic primary pain

www.theguardian.com

 

[Thebearcametoo]

Stories like this are scary. My understanding is that the chronic pain referred to is chronic pain that is not as a result of a diagnosed condition. If there is a diagnosis attached (eg back pain caused by crumbling discs, fibromyalgia, migraines) then this study is not relevant. The reporting of it hasn’t made that as clear as it might have done and it has caused a lot of fear in those of us who do have chronic pain conditions and who take many of the meds mentioned. Plus many of us with chronic pain took more than 5 years to get those diagnoses so the idea of not being treated in those years is terrifying (and there are many people still awaiting diagnosis). The narrative around pain relief that it causes dependency forgets that chronic pain doesn’t go away. There isn’t yet a cure for fibromyalgia so I will be on medication for the rest of my life, medication that helps me to function as an adult who has responsibilities but that still leaves me in pain every day and not capable of holding down a full time job. I am dependent on the drugs and aware of the side effects of long term use (I even take a medication to help offset some of those issues).

Added to that there are systemic issues with diagnosing pain issues - if you are young, female, black or any combination of those then you are likely to take longer to get a diagnosis.

Should counselling and physical therapies be offered, absolutely. But the wait for those is long too (and CBT is not a cure all, try getting anything more than that on the NHS and it’s near impossible).

 

[mikeydt1]

BBC were on about this and crazy boffins were only wanting to replace pain relief with ant-depressants for god sake.

i know migraines are painful and can be treated without pain relief as there are now specific medications which are designed for them from triptans to stuff like naproxen.

issuing or even thinking of prescribing anti-depressants can come with a host of nasty unwanted side effects and even some of them are as addictive as pain killers. boffins with no brains.

i suffer from painful diverticulitis disease and without pain relief i may as well just give up

 

[Robin]

BBC were on about this and crazy boffins were only wanting to replace pain relief with ant-depressants for god sake.

i know migraines are painful and can be treated without pain relief as there are now specific medications which are designed for them from triptans to stuff like naproxen.

issuing or even thinking of prescribing anti-depressants can come with a host of nasty unwanted side effects and even some of them are as addictive as pain killers. boffins with no brains.

i suffer from painful diverticulitis disease and without pain relief i may as well just give up

It’s only talking about pain with no primary cause, as @Thebearcametoo pointed out. The quote from NICE in the Guardian article is
Chronic primary pain is a condition in itself that cannot be accounted for by another diagnosis or as a symptom of an underlying condition, Nice said.
There was a TV programme about this a while ago, and they made it clear that the were only talking about cases where there was no current cause for the pain, but pain memory persisted, and analgesics and morphine had no effect on it, but people were being prescribed ever increasing doses of pain relief until they were zombified and addicted.

 

[Ditto]

What about an aspirin everyday for heart? I keep taking it but it does worry me!

 

[Bruce Stephens]

What about an aspirin everyday for heart? I keep taking it but it does worry me!

There are different concerns for that use. Is the benefit (for CVD reduction) larger than the risks of bleeding? If you've been taking it for a while and your GP hasn't reviewed it (since the last change in general advice) it's probably worth mentioning it. (Taking it is still advised for some people, but not nearly as widely as a few years ago.)

 

[grovesy]

I was stopped Aspirin a number of years ago as the evidence for taking was not backed up by current guidelines.

 

[mikeyB]

The only pain reliever I use is the occasional Tramadol, usually the day after a day of unusual exertion. Most of the time, for general muscle discomfort I use CBD oil. I can't tolerate NSAIDs, and don't want to rely on regular Paracetamol, it's not good for the liver. It seems regular paracetamol is effective for pancreatic pain, but I wouldn't know because I've never had it.

 

[Ditto]

Cripes, that's worrying. My gp's don't review anything, they've not seen me this year, didn't even have last diabetic review. I wish I'd stayed with my old doctor now.

They did mither about me having the camera down but I refused that so maybe they've given up on me with everything.

 

[Bruce Stephens]

Cripes, that's worrying.

I wouldn't worry too much for this. The warnings in some newspapers were (surprise!) a bit exaggerated. It seems quite likely that if your GP were to reconsider your daily aspirin you'd both agree that (on balance) you ought to continue.

Is routine aspirin use not advised?

Experts have warned that “healthy people should not take aspirin to prevent a heart attack because routinely taking the drug does them more harm than good,” according

www.nhs.uk

 

[Ditto]

I will do because I'm too apathetic to do anything else really. I'm doomed so what the heck. I was just hoping for a few extra years but can't do the liquid diet so sucks to me!

 

[Eddy Edson]

There is also a body of opinion that any over-the-counter painkillers containing codeine, eg Co-codamol, should only be available of prescription because of the risk of addiction.

Hope not. Co-codamol is my painkiller of choice.

Martin

The equivalent here in Oz was OTC until a couple of years ago. It was my painkiller of choice, also, mainly for a neck prob I've had since I was a kid. I used to pop a couple most days without thinking about it much & I think I actually might have had a bit of an opioid addiction. But when they went prescription-only I had no probs and discovered that a couple of aspirin worked just as well. And the neck problem started getting a lot better, fwiw, but maybe that had more to do with losing some weight, doing more exercise etc.

 

[everydayupsanddowns]

It seems regular paracetamol is effective for pancreatic pain, but I wouldn't know because I've never had it.

Jane took full-dose paracetamol for her pancreatic cancer pain, and it really helped. They kept up the paracetamol even as the morphine doses were ramping up.