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Non-medical prescribing

Lack of evidence for non-drug interventions for chronic pain 'could limit their inclusion in NICE guidance'

Roger Knaggs, a member of the National Institute for Health and Care Excellence guidance committee, says the lack of development and recognition in social interventions could prevent holistic solutions from being part of national guidelines.

Roger Knaggs, a member of the National Institute for Health and Care guidance committee and associate professor in the school of pharmacy at the University of Nottingham

Source: Charlie Milligan

Roger Knaggs has said the social aspect of pain management is “underdeveloped” in a lot of areas

A lack of clinical evidence to support social interventions to help patients with chronic pain may hamper their inclusion in new national guidance, Roger Knaggs, a member of the National Institute for Health and Care Excellence (NICE) guidance committee, has suggested.

The NICE committee is currently looking at producing the first national guidance on the assessment and management of chronic pain, which is due to be put out for consultation on 21 February 2020 until 3 April 2020. The final document is due to be approved in August 2020.

Speaking to The Pharmaceutical Journal, Knaggs said: “We have known that most medicines for chronic pain in medical settings work for between one in four or one in five people, so it’s not surprising that in real life, rather than in a trial setting, they will work for even fewer people.”

Knaggs, who is also an associate professor in the school of pharmacy at the University of Nottingham, explained that a typical pain management framework for a patient is made up of three elements — bio, psycho and social. Treatment can include medicines, talking therapies, and addressing areas such as social isolation.

“Historically we have been better with the bio [element] and increasingly the psycho is better recognised as benefitting a lot of people; but in a lot of areas the ‘social’ is underdeveloped,” he said.

This lack of development and clinical evidence around the social steps, which patients can take to help alleviate chronic pain, could be a barrier to more holistic solutions being adopted in national guidelines, Knaggs suggested.

“[The NICE committee has] looked at a range of different interventions and managements to help support people with chronic pain, but we can only make recommendations where there is some level of evidence — there has to be some burden of evidence that there is some benefit,” he said.

“It’s still relatively early days as far as social [interventions and evidence is concerned] but I think the balance is shifting.”

Knagg’s comments come as an investigation by The Pharmaceutical Journal, published in February 2019, found that the majority of patients living with chronic pain in Great Britain are having to wait significantly longer than recommended for specialist help to manage their symptoms, with some waiting two years after being referred by their GP.

Special report: Non-drug interventions

This article is part of a special report on the increasing use of non-pharmacological treatments in the health service.

Click here to find out more

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207685

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