Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NICE NG193)
by National Institute for Health and Care Excellence · NICE
The clearest authoritative statement of what works and what does not for chronic primary pain, with notable 'do not offer' recommendations on common drugs. Essential counterweight in a fad-prone field. UK national clinical guideline published April 2021 covering assessment of all chronic pain and management of chronic primary pain: which treatments to offer (exercise, psychological therapy, acupuncture, some antidepressants) and which drugs not to start, including opioids and gabapentinoids.
More resources on Chronic Pain
CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022
US federal guideline from November 2022 with 12 recommendations on whether to start opioids, choosing doses, prescription duration and follow-up, and assessing harms, set alongside the evidence for non-opioid and non-drug treatments for chronic pain. Covers the medication side of the topic note in more depth than NICE, especially long-term opioid use and tapering.
The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises
2020 IASP task force paper in Pain presenting the first revision of the definition of pain since 1979, with six notes separating pain from nociception, stressing biopsychosocial influences, and explaining the reasoning behind each wording choice.
Psychological therapies for the management of chronic pain (excluding headache) in adults
2020 Cochrane systematic review of randomised trials comparing cognitive behavioural therapy, behavioural therapy and acceptance and commitment therapy with usual care or active controls for chronic pain, reporting effects on pain, disability and distress. Its measured conclusion (small but real CBT benefits, uncertain evidence for BT and ACT) is the calibrated view learners need when evaluating newer psychological pain programmes.
Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews
2017 Cochrane overview synthesising 21 reviews across conditions including osteoarthritis, fibromyalgia, low back pain and neck disorders, assessing whether exercise reduces pain severity and improves function, and whether it causes harm. Free full text.
painHEALTH
Free self-management site for persistent musculoskeletal pain with written and video modules on neuroplasticity, pacing and goal setting, movement, sleep, mindfulness, medicines and procedures, plus condition pages, self-check questionnaires and patient stories. Moves the learner from understanding pain to managing it day to day, organised as structured modules that follow current evidence. Government and university backed.
Explain Pain (2nd Edition)
Illustrated 2013 book explaining how the brain constructs pain, how immune, autonomic and motor responses contribute, and why pain can outlast tissue healing. Written in plain language for people in pain, their families and clinicians. Recommended by Tame the Beast and pain physiotherapists as the entry text for both patients and clinicians.