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Common Painkillers ‘do more harm than good’ for Chronic Primary Pain according to new draft guidance published by the NHS & NICE.
Senior NHS officials disclose that aspirin, ibuprofen, paracetamol and opioids are all unsuitable for chronic primary pain.
Painkillers that are commonly recommended by doctors and sold over the counter in pharmacies and supermarkets. Drugs such as ibuprofen, aspirin, paracetamol and opioids can cause “more harm than good” and should not be prescribed by doctors to treat chronic primary pain. A statement made by health officials has said.
The National Institute for Health and Care Excellence (NICE) said that there was “little or no evidence” that commonly used drugs for chronic pain improved people’s quality of life, pain or psychological distress. The guidance published on 03 August 2020 said that there was evidence that the painkillers can cause harm, particularly addiction. Prescribing drugs that can cause the patient to become addicted is obviously undesirable as it increases the sufferer’s burden rather than improving their daily life.
Chronic primary pain cannot be accounted for by a typical diagnosis and it will be interesting to see whether NICE have guidance on other Chronic Pain conditions such as Fibromyalgia, Arthritis & Rheumatoid Arthritis. Chronic primary pain causing great emotional distress and limits a sufferer’s mobility. The pain can be widespread and even chronic musculoskeletal pain in some cases.
This guidance will help doctors decide upon the most appropriate treatment for patients. Chronic Pain conditions are very specific to each patient and it can be a complex task to find the ideal treatment for patients. There is an expectation from many patients for a doctor to be able to prescribe something that can eradicate the pain. The options that are successful in preventing pain can have detrimental long-term side effects and as the recent NICE guidance suggests the drugs can do more harm than good. This clearer understanding of the evidence for the effectiveness of treatment of chronic pain should lead to an improvement of the confidence of doctors in their conversations with their patients.
NICE declared that approximately 30-50% of the population may be affected by chronic pain and almost 50% of people with chronic pain also have a diagnosis of depressions. While 66% of sufferers are unable to maintain full time employment due to their condition.
The NICE guidance seems to suggest that patients should be offered alternative treatments and therapies. Supervised group exercise programmes are one example of an alternative therapy that could help patients deal with their chronic conditions. Forms of psychological therapy are another alternative, this may help those dealing with chronic pain to find coping strategies and discover methods to manage their pain. Acupuncture was also mentioned within the guidance.
The NICE guidance did also disclose that some antidepressants should be considered for people dealing with chronic primary pain.
The guidance stated that paracetamol, anti-inflammatory drugs such as aspirin and ibuprofen or opioids should not be offered to patients because there was little or no evidence at all to prove that these drugs made any improvement to people’s pain, quality of life or their psychological distress. However, there was evidence that these drugs can cause harm to the user and can even cause addiction.
The drafted NICE guidelines also revealed that anti-epileptic medication such as ketamine, corticosteroids, anti-psychotics and gabapentinoids should not be prescribed to patients to manage chronic primary pain as there was little or no evidence concerning the efficacy of these medications.
Ineffective treatments can be extremely disheartening for patients and it is imperative that there is an understanding about how pain disrupts a person’s life and their family. Understanding this should be the first step in providing treatment and deciding upon the best course of action and developing an effective care plan.
While the draft guidance does provide numerous findings about drugs used to manage pain, there is still a tremendous amount of research that needs to be carried out to assess the range of possible treatment options.
There is an immediate need for an alternative option for doctors and patients. The alternatives must have significantly less serious side effects and no long-lasting negative impact. Cost is also a factor as paracetamol and ibuprofen are quite cheap. The instant relief provided by the drugs that replace paracetamol, ibuprofen and aspirin need to provide an almost instant relief from pain to allow sufferers to manage their pain.
Could CBD be a long-term replacement for existing painkillers?
CBD is one of many cannabinoids naturally found within the cannabis plant. CBD does not cause the psychoactive effect that is often associated with cannabis, it is the cannabinoid THC that causes the infamous ‘high’.
The initial research into CBD and pain management shows promise. CBD could provide an alternative to those suffering from chronic pain and who rely on opioids or other habit-forming medications. More research needs to be carried out to verify the pain-relieving effects of CBD oil and other CBD products beyond reasonable doubt.
With the approval from the MHRA and the Food and Drug Administration (FDA) in the United States, Epidiolex, is now prescribed to patients who suffer from epilepsy. This is an illustration of how medical opinions and institutions are beginning to appreciate the prospective treatments that could be developed using CBD.
CBD operates by interacting with the endocannabinoid system (ECS). Many researchers believe that CBD interacts with one of the core components of the endocannabinoid system, the endocannabinoid receptors in the human brain and immune system. The endocannabinoid receptors are miniscule proteins that are attached to cells. The receptors receive signals, often chemical signals from various stimuli and then assist the cells with their response.
The response enables anti-inflammatory and pain-relieving effects that may help with pain management. This effect on the body means that CBD oil may benefit those who live with chronic pain.
There was a study into how well CBD worked to relieve chronic pain. The study was undertaken in 2018 and was compared with a similar study that took place in 1975. Both studies examined various types of pain such as fibromyalgia, neuropathic pain and pain in cancer patients. The findings of these studies concluded that CBD was effective in overall pain management and did not cause any severe side effects.
There was a 2016 study that analysed the use of CBD in rats with arthritis. The researchers applied a CBD gel to the rats for 4 days. The rats were given either 0.6mg, 3.1mg, 6.2mg, or 62.3mg each day. There was a noted reduction in inflammation and pain in the rats’ affected joints. No side effects became apparent in the study. The rats that received lower doses of 0.6mg and 3.1mg did not improve their pain scores. 6.2mg was found to be a dose high enough to reduce the pain and swelling.
The rats that were given 62.3mg had similar outcomes to the rats that received 6.2mg. Receiving a substantially larger dose did not result in a further decrease of pain.
While this kind of research is promising, human clinical studies and human clinical trials are needed before there will be definitive evidence of how CBD can help chronic pain sufferers manage their pain. More studies in humans are needed to substantiate the claims of CBD being a proponent of pain control.
In November of 2019, a study was conducted to investigate the effects of CBD hemp extract on opioid use and quality life indicators in chronic pain patients. It was found that CBD significantly reduces opioid painkiller use in patients who struggle with chronic pain conditions.
The study found that 53% of chronic pain patients reduced or eliminated their prescribed opioid use within 8 weeks of adding CBD to their pain management. Of the study’s participants, 94% reported that their quality of life had been improved after they began taking CBD. The researchers suggested that there was a strong relationship between CBD and the improvements in chronic pain intensity as well as a better sleep quality.
All too often patients can become dependent on opioid medications which carry a risk of tolerance and subsequent physical dependence. Opioids have multiple adverse side effects such as constipation and somnolence, of course not forgetting the potential of a lethal overdose. This is why there needs to be an enormous effort to provide patients with alternative options with a better safety profile and comparable efficacy.
The study consisted of 131 patients that were recruited from a pain management clinic. Of the 131 patients, 97 completed the 8-week CBD research study. The patients were aged between 30 & 65. Prior to taking part in the study, all patients had been using opioids for at least one year to treat chronic pain symptoms.
The improvements in chronic pain symptoms were evaluated using 4 tests:
- Pain Disability Index (PDI-4)(positive trend results, but not significant)
- Pittsburgh Sleep Quality Index (PSQI) (a significant improvement from CBD use)
- Pain Intensity and Interference (PEG) (a significant improvement from CBD use)
- Patient Health Questionnaire (PHQ-4) (positive trend results, but not significant)
The conclusion that can be drawn from the study is that CBD could reduce opioid use and improve the quality of sleep for patients who have been regularly prescribed opiates for chronic pain.
CBD may be a natural solution to millions of people around the world to make their daily lives more bearable. Living in constant pain is a terrible burden and can erode many facets of your life. Working full time becomes near impossible and maintaining a social life becomes extremely difficult.
There are many believe that THC is required in order to feel the full therapeutic benefits of the cannabis plant and in particular, THC is the most effective cannabinoid for pain relief. More research has been carried out into the efficacy of Medical Cannabis than CBD. However, there is still a huge amount of research and studies that need to take place before Medical Cannabis will be available on the NHS.
Medical Cannabis was legalised in the UK in November 2018. However, restrictions concerning imports and several other factors has meant that it has not been easy for patients to gain access to Medical Cannabis.
The primary problem with Medical Cannabis in the UK at this time is the cost. Patients currently have to first pay for an eligibility consultation and then an appointment with a doctor from a registered Cannabis Clinic. This cost is normally in the region of £150. The patient then has to pay for the cost of the medication, which for a month’s supply can result in a cost of in excess of £500. This is simply unaffordable for the majority of the population, especially those who experience from chronic pain as many sufferers are unable to work.
For Medical Cannabis to be cemented within society’s consciousness as a viable alternative to opioids and other painkillers, it has to be made more accessible. This is likely to come in the form of subsidisation from the government and NHS. However, for this to materialise there will have to be clinical trials. Clinical trials are extremely expensive and the pharmaceutical companies that usually carry out such large trials have a vested interest in ensuring that there is not clinical evidence supporting the efficacy of Medical Cannabis, due to the fact that opioids are big revenue stream for most large pharmaceutical companies.
There is building evidence to support the efficacy of THC treatment options as well as combinations of THC & CBD.
Pain is the most common reason why people seek medical advice or treatment. Patients seeking pain relief are the most prevalent section of patients requesting Medical Cannabis. Chronic pain seriously inhibits the quality of life for many patients and can lead to depression or substance abuse.
Early findings seem to suggest that the use of Cannabis does not necessarily provide complete pain relief but it does allow the patient to no longer be preoccupied with the pain, meaning they are able to ignore it and live their life without the constant obsessing over their chronic pain. In cases where inflammation is a key source of the pain, cannabis decreases the inflammation that causes the pain resulting in effective relief. Many chronic pain patients have been prescribed various drugs to help them cope with their pain. This can consist of strong opioids such as tramadol, morphine, hydrocodone and oxycontin. The use of cannabis, in most cases results in a significant decrease or elimination of the patient’s use of these opioids.
Below are several interesting studies into the impact cannabis can have on those who suffer from chronic and neuropathic pain.
It is crucial that treatments that can cause long-term harm to patients are not widely prescribed and it is imperative that alternative treatment options are researched and developed.
Cannabis has the potential to be the perfect solution. However, more research and clinical trials are needed to ensure that the evidence is available to provide to doctors and Medical Governing bodies with definitive proof of the efficacy of Cannabis in treating pain and other conditions.
A natural evolution of how patients suffering from chronic pain may be upon us and this should ultimately result in patients treating their illnesses with medications that do not cause long-term damage and provide short-term relief.