Chronic pain (primary and secondary) in over 16s: summary of NICE guidance

What you need to know

• A collaborative and supportive relationship between healthcare professional and person with chronic pain and a comprehensive person-centred assessment are central to good management

• With the exception of antidepressants, initiation of pharmacological management is not recommended.

• Offer supervised group exercise to people with chronic primary pain

Identifying chronic primary pain

Chronic primary pain has no clear underlying condition, or the pain or its impact seems to be out of proportion to any observable injury or disease. All forms of pain can cause distress and disability, but these features are particularly prominent in presentations of chronic primary pain.

The guideline is consistent with the ICD-11 definition of chronic primary pain: “Chronic primary pain is chronic pain in one or more anatomical regions that is characterised by significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). Chronic primary pain is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate independently of identified biological or psychological contributors unless another diagnosis would better account for the presenting symptoms.”4