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Chronic Primary Pain Management — FRCA Final MCQ

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HardPain MedicineChronic Primary Pain ManagementFRCA Final

A 40-year-old woman has chronic widespread pain that has persisted for more than 3 months. Clinical assessment has identified no underlying condition that adequately accounts for the pain or its impact, and chronic primary pain is diagnosed. She does not have depression. According to NICE NG193, which pharmacological approach may be considered specifically to manage her chronic primary pain?

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Reveal the answer and explanation

Correct answer: E — Initiating an antidepressant after discussion of its potential benefits and harms

NICE recommends considering amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline for adults with chronic primary pain after discussing benefits and harms. Antidepressants may improve pain, sleep, quality of life and psychological distress even without depression. By contrast, NICE advises against initiating antiepileptic drugs, including gabapentinoids, opioids or paracetamol for chronic primary pain. This restriction concerns initiation: patients already taking such medicines require an individualised review rather than automatic abrupt cessation. Option A is therefore incorrect because NICE does not exclude all medication; antidepressants remain a possible treatment alongside supervised exercise, CBT or ACT, and a limited course of acupuncture.

Reference: National Institute for Health and Care Excellence. NG193, Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, recommendations 1.2.7–1.2.10. 2021. https://www.nice.org.uk/guidance/ng193/chapter/recommendations