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NICE is the opioid of the people



So my gut reaction to the news that NICE won’t let us prescribe opioids or NSAIDs anymore to people in chronic pain was the same as yours, that is to say, look, NICE, I’ve cut you some slack over the years and even praised elements of your guidance (GORD in children) even if I have slagged off some too (everything else) but this time YOU HAVE GONE TOO FAR because you are taking no notice of key factors like the ten-minute consultation, patient demand, pragmatism, unavailability of resources, doctor despair, the need for a therapeutic white flag etc etc, in other words, in case any of us needed any evidence (which NICE is big on, apparently) that NICE knows nothing about the realities of general practice then THIS IS IT, and what’s more they have the gall to drop this grenade mid-Covid while we’re anticipating the shittiest winter ever and that’s why I feel moved to say to NICE, with as much frustration, disbelief and venom as I can muster, JUST PISS OFF.

But then my brain took over. And I thought, maybe I should actually read the draft guidance, and guess what? It’s fine. No, really. There’s a massive get out whereby, for specific conditions that cause pain like headaches, back pain, OA et al, then we can knock ourselves out, or at least the patients, with as much paracetamol, NSAID or, yes, (sometimes) even opioids if we wish. Phew.

My gut reaction to the news that NICE won’t let us prescribe opioids or NSAIDs anymore to people in chronic pain was the same as yours

Because what NICE’s restrictions apply to is ‘chronic primary pain’, which they define as ‘pain in one or more anatomical regions…characterised by significant emotional distress or functional disability’, which is ‘multifactorial: biological, psychological and social factors contribute to the pain syndrome.’

Oh, right. Now I get it. People who are a little bit, you know, what lesser, unkinder doctors would call bonkers, but who obviously are genuinely distressed and who obviously need… ta-da… antidepressants. Which is exactly what we give them! And it’s what NICE recommends, after, of course, group exercise, acupuncture, CBT and, uh, ‘acceptance and commitment therapy’ (me neither).

And relaxation does seem to work because five minutes ago I was that close to my secret stash of Zapain.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield

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