Challenges of Treating Chronic Pain
Chronic pain is a complex and difficult condition to treat despite the progress in neuroscience research over the last two decades. A recent overview by Ferreira and colleagues has added to the growing body of evidence on the use of medicines for pain, highlighting the limitations of current medical treatments.
Assessment of Antidepressants for Chronic Pain
In recent guidance from the UK National Institute for Health and Care Excellence, only antidepressants were found to have a favorable balance of benefits and harms for chronic primary pain. However, Ferreira and colleagues found that the evidence for their effectiveness in a wider range of chronic pain conditions was limited, with only 11 of 42 comparisons showing some level of effectiveness, none of which was of high quality. This suggests that most people living with chronic pain are unlikely to experience significant relief from antidepressant treatment.
Alternative Options for Pain Management
Group exercise, led by qualified instructors, has been shown to be effective in managing pain symptoms and has many other health and well-being benefits. In addition, non-medical services such as mobility support, debt management, and social connection can be helpful for people living with pain. Social prescribing, which refers to linking people with appropriate local support, is a promising approach, but its effectiveness is still evolving.
The Importance of Personalized Care
A strong, empathetic relationship with a care provider is crucial for successful pain management. People living with pain value time to discuss their concerns and easy access to support, and personalizing care is crucial for successful pain management. Research has traditionally focused on measures like pain scales and physical function tests, but new research should aim to understand the broader experience of living with pain.
Public Involvement in Pain Research
Public involvement in health research is crucial to ensure that pain research is meaningful and relevant to those living with pain and their clinicians. Researchers must involve people living with pain in their studies and overcome the barriers to public involvement in health research. Building new partnerships between clinicians, people living with pain, and researchers is crucial to improve care and research for chronic pain.
Chronic pain is more than just a medical condition and the limitations of current medical treatments present an opportunity to change the way we think about pain and focus on the individual experience of living with it. All stakeholders must share the responsibility of building these new partnerships to improve care and research for chronic pain.
- Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-072415 (Published 01 February 2023). https://www.bmj.com/content/380/bmj-2022-072415
- Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain .NICE guideline [NG193]. https://www.nice.org.uk/guidance/NG193