Understanding chronic pain in the UK
Chronic pain is a significant and widespread issue in the UK and is thought to affect between one third to one-half of the UK population. This means that millions of people are living with ongoing pain that persists for months or years, affecting their quality of life and ability to work.
Musculoskeletal conditions continue to be the number one cause of disability in the UK, and the global trends predict that this figure will rise. For instance, the years lived with disability due to low back pain increased by 54% from 1990 to 2015 and are expected to keep rising.
If you have been experiencing chronic pain, you may have been prescribed some form of pain relief, which is usually seen as the easiest solution for managing pain, however this approach has its drawbacks. Public Health England (PHE) reported that over half a million people have been using opioid painkillers for chronic conditions, like lower back pain, for more than three years. While these drugs can provide short-term relief, they carry risks such as dependency and side effects, and they often do not address the root cause of your pain.
What is chronic primary pain?
Chronic primary pain is a long-lasting pain condition, where pain persists for more than three months, and cannot be fully explained by another medical diagnosis. Unlike acute pain, which signals tissue damage or injury, and resolves with healing, chronic primary pain does not appear to serve a clear protective function, and often persists despite the original injury having healed.
This type of pain can include conditions such as chronic migraines, complex regional pain syndrome, and fibromyalgia.
If you are living with chronic primary pain, you will be familiar with the impact that this has on your quality of life, as it is often accompanied by significant physical, emotional and social challenges. You may notice it starts to affect your wider relationships too and become anxious about the impact it has on your ability to work or engage in meaningful activities.
NICE guidance on chronic pain and pharmaceutical interventions
If you are living with chronic pain, it’s helpful to understand the available treatment options and the potential benefits and risks of these.
Painkillers can be a practical solution for short-term relief, but there are safer and more effective alternatives for managing long-term pain. Unfortunately, the structure of the UK healthcare system means these alternatives are often not utilised as much as they could be.
The National Institute for Health and Care Excellence (NICE) is an organisation in the UK that provides evidence-based guidelines and advice to improve health and social care practices. NICE guidelines provide recommendations to help healthcare professionals and their patients to make informed decisions about their care, including treatment and management options of particular conditions.
According to the latest NICE guidelines for chronic primary pain, most drug treatments for chronic pain are unlikely to provide enough benefit to outweigh their associated risks. The only exception to this may be antidepressants, which could offer some relief.
Recent evidence points instead to a range of effective non-drug treatments for chronic pain. These include exercise programmes, psychological therapies such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT), and acupuncture.
There are certain treatments which should not be recommended to you for managing chronic primary pain. These include transcutaneous electric nerve stimulation (TENS), interferential therapy, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, and opioids. The reason these treatments are not recommended is because they haven’t been shown to significantly improve quality of life, reduce pain levels, or alleviate the psychological distress that often accompanies chronic pain. Instead, they may carry the potential for harm, such as the risk of drug addiction.
How can a chiropractor support you?
At your first consultation with your chiropractor, they will ask you about any medication you are taking and the reasons for taking it. If you are taking any drug treatments for chronic primary pain, please let your clinician know. Do not stop taking any medication without speaking to your GP first. This helps to ensure there is a suitable, safer and more effective alternative available for you, and supports collaborative decision-making with your GP.
There isn’t currently enough evidence to support manual therapy as a recommended treatment for primary pain. This prevents NICE from including them in their guidelines. The guidelines instead conclude that manual therapy, when compared to usual care, shows promising benefits and no evidence of harm. This suggests that future research may lead to the inclusion of manual therapy in recommended treatment plans.
Chronic primary pain can be best managed with a multidisciplinary approach, where your treatment focuses not only on your physical symptoms, but also addresses your psychological well-being and lifestyle factors to help improve your quality of life.
Chiropractors are regulated primary care practitioners who are well positioned to support you in addressing the related issues that often accompany chronic pain, such as anxiety, stress, difficulty in relaxing and ongoing muscle tension. Managing chronic pain can be complicated, and chiropractors are well placed to support you through active listening, education, exploring how pain affects your life, and creating a tailored plan to help you on your road to recovery. Your practitioner will work closely with you to guide you throughout your treatment journey, empowering you to take control of your own health.
Useful resource for patients
References
Harvey-Sullivan, A., Higginbottom, S. and Round, T. (2022) ‘NICE chronic primary pain guidelines: what the busy GP needs to know’, British Journal of General Practice, 72(718), pp. 240-241. doi: 10.3399/bjgp22X719453.
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