Great Britain

Why drugs don’t work for long-term pain & what alternatives are available

HEALTH watchdogs have warned how painkillers can “cause more harm than good” for those with long-term ailments.

On Monday, the National Institute for Health and Care Excellence (NICE) said there was no evidence that pills including ibuprofen and paracetamol “made any difference to people’s quality of life, pain or psychological distress”.

In draft guidance, NICE said that people suffering with chronic pain should not be popping pills, and it highlighted the need for better methods for diagnosing and tackling the problem.

Around 28 million adults in the UK – about 43 per cent of the population – suffer from “chronic primary pain”, which is defined within the guidelines as a condition that “can’t be accounted for by another diagnosis”.

Doctors often define it as any pain that lasts for three to six months or longer.

Here, The Sun’s doctor reveals the truth about popping pills for pain – and gives advice on the alternatives available.

AS any GP will tell you, too many people rely on too many painkillers.

I’m talking about aspirin, paracetamol and ibuprofen, as well as common prescription painkillers such as co-codamol and co-dydramol.

There are also stronger opiates such as tramadol.

While they are fine for short-term conditions such as injuries and the after-effects of surgery, problems can arise when pain is more persistent.

One snag is that some painkillers become less effective over time.

Ibuprofen and other anti-inflammatory drugs can also upset the stomach and even cause ulcers.

With paracetamol, there is a fine line between an effective dose and a toxic one, which damages the liver.

Painkillers can be addictive, especially codeine and tramadol.

I’ve had patients using painkillers including co-codamol to deal with on-going back pain, taking ever higher doses to control it.

Sometimes they are offered tramadol instead, but this can cause fatigue. As a result, some patients have had to give up driving, which has limited their life even more.

Another patient kept requesting painkiller prescriptions although, as he admitted, he no longer had much pain.

Another young man managed to get an illicit supply, which accidentally killed him.

Health Secretary Matt Hancock said last year he was “incredibly concerned” by the rising trend of doctors prescribing pain pills, sleeping tablets and anti-depressants, calling it a “crisis”. 

The stats revealed around one in eight were given potentially addictive opioid painkillers.

Figures showed some 11.5million patients had been prescribed with pills in the previous year.

Addictive opioids

Mr Hancock said: “The disturbing findings, especially that one in eight adults are taking super-strength, addictive opioid painkillers, proves to me that we are in the grip of an over-medication crisis.”

Attempts to treat chronic pain are costly to the healthcare system.

Millions of pounds are spent each year on prescribing analgesics.

I have a great deal of sympathy for sufferers of chronic pain but relying on medication is not necessarily the solution.

Many of the patients I see are reluctant to take medication on a long-term basis. Some of them are well aware of the dangers.

While there is a time and place for painkillers, they are not a cure for persistent pain.

The sad fact is that there is no surefire remedy. Cognitive behavioural therapy (CBT) and other therapies can help someone live with their pain. 

There has also been a lot of interest in self-management programmes.

These focus on self-help to get patients fitter, pace activities, improve sleep and relaxation and use the person’s own skills to help them return to a more enjoyable life. However, not everyone benefits. 

Sufferers often develop significant emotional distress and find it difficult to function in everyday life, something I have seen in my own consultation room.

I’ve seen patients with crippling pelvic pain, others with back or neck pain, and quite a few with something called complex regional pain syndrome, which usually affects one arm or leg and can be very disabling.

Nobody really knows the cause but it can occur after a shoulder injury.

One of the worst things about it, according to one woman, is that even a light touch on the arm is felt as pain.

It is estimated that almost half of people with chronic pain have a diagnosis of depression and two-thirds are unable to work outside the home.

There is something very corrosive about living with pain day in and day out.

Persistent pain isn’t in the mind. But it is inside the brain. It changes the way brain cells work, and finding out more might better serve sufferers, or might prevent pain becoming persistent.

Trying to get effective treatment can be lengthy and frustrating, leaving sufferers feeling helpless.

And GPs like myself often find it challenging to help patients manage the condition.

False promises

I agree current treatments don’t live up to patient expectations or get rid of their symptoms. But what is going to take their place?

At the moment, most people get by with a patchwork of treatments, from lifestyle changes, exercise or physio, counselling and medication.

I still believe painkillers have a place if prescribed carefully, and that they help those with chronic pain to lead more normal lives. I also know from experience how desperate people can get.

If we deprive them of these drugs without offering something better right away, they could be driven to alternative practitioners who may be unscrupulous and falsely promise to cure a condition nobody else can.

The alternatives to medication 

HERE are some helpful alternatives to pain-killing drugs: 

  • Exercise can help by increasing patients’ mobility and function, raising levels of “feelgood” endorphins and improving their general health.
  • Acupuncture, available on the NHS, is useful for people with all kinds of pain. However, it doesn’t work for everyone and is not available everywhere.
  • Antidepressants, also available on the NHS, tackle depression but also work in their own right for chronic pain, especially nerve pain. It is not clear exactly how they help but may modify the chemicals behind the brain’s “pain signals”.
  • CBT (cognitive behavioural therapy), available on the NHS, can help someone cope more positively with pain. It aims to change the way you think so both mind and body respond better to attacks of pain.
  • ACT (acceptance and commitment therapy), which is not free on the NHS, is a mindfulness technique which aims to improve meaningful quality of life despite pain.
  • Pain Toolkit workshops – also not free on the NHS – are available for healthcare professionals and those living with persistent pain. Participants learn how to self-manage pain and overcome daily problems. Patients can access the paid-for Pain Toolkit and ACT via an app. 
Shirley Ballas was in horrific pain and lowered painkiller dose for Strictly filming after breast implant surgery

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