About the guidelines on painkillers

The National Institute for Health and Care Excellence has released new guidelines this week about how to treat chronic pain patients and it has not gone down well amongst many sufferers I have spoken to and it does not entirely sit well with me. The guidelines suggest that primary chronic pain sufferers should not be prescribed painkillers because they don't work and treatment should focus more on acupuncture, exercise, CBT and Acceptance and Commitment Therapy.

There are many issues to delve into here. Firstly, I would agree that it is vitally important that we treat chronic pain holistically and therefore, any medication does need to be carefully considered. There is much evidence that medication and painkillers don't work and I have tried many medications which I have stopped taking if I felt that I wasn't really getting any benefits. However, I now do take an anti-depressant (not because I'm depressed but because this can help to reduce the signals sent to my brain that indicate pain which is not physically there) and I also take Codeine (an opiod painkiller) when my pain is significantly bad. Both of these medications make my pain better and without Codeine there would be more days where I would be lying in bed unable to do anything (and by this I mean, anything, including watching TV). Therefore, there is a time and a place for medication and if it works and improves the quality of life of a sufferer, this can then further improve pain as, let's face it, my mood is significantly improved by being able to do the things I want to do, and value, as opposed to lying in bed in pain.

I mentioned primary chronic pain - i.e. there is no physical cause - it is usually neuropathic and this is why analgesics (painkillers) do not work as they are designed to treat physical causes. However, there have been many occasions and examples where physical causes have not been found for years and furthermore, many people have both primary and secondary chronic pain (where there is a cause). I'm no expert, but from what I have learned about pain, I imagine that secondary chronic pain quite often leads to primary chronic pain.

When I first experienced chronic pain, all I wanted was a fix. Every other condition I had had in my life, there had been some medication, along with rest, which had helped me to recover from that illness and I couldn't understand why this would be any different. I was wary, even at 14, about being put on painkillers and whilst I used them to help, my mum also helped me to get physiotherapy. This helped me to manage my pain but I can now not remember a time where I had no pain at all. Those days don't exist for me anymore. Over the years, I have constantly been looking for some sort of fix and when I finally was able to get an MRI, aged 25, I was absolutely devastated when it showed that there was nothing physically wrong with me. To me, this meant that my pain was never going to be fixed and that was difficult for me to accept. Over the past year, I have been supported by a pain clinic and this has helped me to find ways in which to manage my pain but painkillers are a part of that management, along with mindfulness, yoga and physiotherapy. The concern here is that by taking painkillers away from chronic pain sufferers you are taking away/not providing them with part of their support mechanism and their management of their pain. The painkillers may well enable them to be able to access the more holistic approaches such as exercise and physiotherapy. When I have a flare, I am in so much pain I cannot walk down the stairs or into the next room, never mind "exercise".

My final argument is the cost of these other treatments/management methods. I had physio on the NHS, aged 17. The physiotherapist saw me for 6 weeks, told me that he knew I would need regular physiotherapy, but that our sessions had come to an end - i.e. I could no longer have it on the NHS. Therefore, I have paid for my own physiotherapy since then (with my parents' help). It is around £40 a session, at the best prices. As a student, I had to pay these prices to help me with my pain. As an adult, this is still something I have to factor into my spending. Acupuncture, CBT, and even some Acceptance and Commitment Therapy courses all cost money. This is something that may not be an option for all sufferers. There needs to be more investment in these services and the pain clinics around the UK.

Am I glad that we are moving away from throwing painkillers at chronic pain patients, potentially creating addictions and understanding that they don't always work? Yes. Do I think they should be removed from the holistic approach to managing pain completely? No. We need to talk more about what helps pain patients and it needs to come from their experiences too, not just the "science".