Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For adults with chronic primary pain, NICE recommends considering an antidepressant, such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline, after a full discussion of benefits and harms NICE NG193.
Do not initiate NSAIDs, opioids, or gabapentinoids (including pregabalin) for chronic primary pain, as evidence for their effectiveness is lacking and they may cause harm NICE NG193.
If a person is already taking these medications, review the prescribing and consider stopping if benefits are minimal or harms are significant, following shared decision-making NICE NG193.
Self-management and non-pharmacological approaches are also recommended as part of the management plan NICE CKS.
Key References
- NG193 - Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain
- CKS - Chronic pain
- CKS - Analgesia - mild-to-moderate pain
- CKS - Palliative cancer care - pain
- CG173 - Neuropathic pain in adults: pharmacological management in non-specialist settings