What are the recommended first-line pharmacological treatments for chronic pain in adults according to NICE guidelines?

According to NICE guidelines, the recommended first-line pharmacological treatment for chronic primary pain in adults is an antidepressant, such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline, after a full discussion of benefits and harms ¹.

Non-pharmacological treatments are preferred, and medicines such as NSAIDs, opioids, paracetamol, antiepileptic drugs including gabapentinoids, antipsychotics, benzodiazepines, corticosteroid trigger point injections, ketamine, and local anaesthetics are not recommended as first-line treatments for chronic primary pain ¹.

If a person is already taking any of these medicines, review the prescribing as part of shared decision-making, explaining the lack of evidence for their use in chronic primary pain and considering safe discontinuation if appropriate ¹.