If you ask anybody who has experienced acute pain due to an injury, surgery, whoever you ask, no matter their age, background or gender, there will be one consistent theme – no one will ever want to experience that pain again. Now consider walking in the shoes of someone who lives with a similar level of pain every day, year after year. It’s not hard to imagine why someone living with such a condition would seek relief.
That is what most people living with chronic pain pursue: relief. Relief from a persistent pain that impacts their daily lives. Mental health issues such as anxiety and depression often accompany chronic pain, affecting 46 per cent of people living with persistent pain. Unlike a singular episode of debilitating pain, this is a life lived wrestling a complexity of issues that are intricately linked.
For people living with chronic pain, it is disrespectful and can often be insulting, when their reality of living with these conditions is questioned. In what has become an increasingly common trend, doctors around the globe are being asked to meet a person’s request for pain relief with a host of inadequate responses.
In the United Kingdom, the National Institute for Health and Care Excellence (NICE) has advised that a range of commonly used painkillers for chronic pain ‘can do more harm than good’ and should not be used. In draft guidance published in August, NICE said paracetamol, non-steroidal anti-inflammatory drugs (which include aspirin and ibuprofen), benzodiazepines or opioids should not be offered to those suffering from chronic primary pain. Instead, the draft guidance recommends antidepressants, acupuncture or psychological therapy.
The intent behind the policy may be to reduce harm and stem over-reliance on medications alone to manage complex chronic pain conditions requiring a whole host of solutions working in tandem to meet the goals unique to each individual.
But far more harm than good is likely to arise from knee-jerk responses that take away existing treatments that are working to keep people functioning, without providing any supports and alternative treatments for those most impacted by these decisions. In what is likely to be a cruel repetition of similarly failed implementation of the Centre for Disease Control (CDC) guidelines in the US, and the most recent tranche of opioid reforms in Australia, throwing the baby out with the bathwater is unlikely to result in positive outcomes for anyone.
We must recognise the main reason why medications remain the most common approach to managing complex pain presentations – they are affordable, accessible and effective for some people. While the gold standard in pain management is a biopsychosocial model – which changes the line of clinical inquiry from ‘what is the matter?’ to ‘what matters to you?’ – this approach remains inaccessible to most people.
Paying out of pocket for multi-disciplinary care which can range from finding and building a team that includes a pain specialist, a psychologist, a dietitian, a physio etc, is not an affordable option for many consumers.
Even with access to varied and multiple therapies, we must also recognise that for some people, medications will remain the most affordable and effective way to address pain or at least an important part of a treatment regime.
As we have outlined in our submission to the draft NICE Guidelines this week, ensuring quality of life for the millions of people experiencing chronic pain must be our priority. We cannot keep trying to cobble together ad-hoc responses while not investing in the solutions and ultimately failing the very people we want to help.