Not really nice: a commentary on the recent version of NICE guidelines [NG193: chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain] by the Pain Net

Korwisi, Beatrice; Barke, Antonia; Kharko, Anna; Bruhin, Clara; Locher, Cosima; Koechlin, Helen

doi:10.1097/pr9.0000000000000961

Cited by 31 publications

(16 citation statements)

References 12 publications

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“…Dietary counseling and weight reduction for patients with a BMI greater than 25 can significantly decrease hip pain. 3,16,[21][22][23] New guidelines from the National Institute for Health and Care Excellence 16 recommend an exercise program and physical activity as a priority over medication administration for chronic pain. Self-management to decrease pain may include activities such as aquatic exercises, stretching, weight training, and aerobics.…”

Section: Managementmentioning

confidence: 99%

“…16 An example of acute pain is a fractured hip; CPP, pain from a primary source after 3 months such as osteoarthritis; CSP, pain that originates from another source such as rheumatoid arthritis. 16 Physical activity can play a major role in hip disorders and pain. A sedentary lifestyle is a risk factor for poor muscle tone and weight gain that increases stress on the hip.…”

Section: Health Historymentioning

confidence: 99%

“…Patient education includes activity modification and weight loss to mitigate excessive weight-bearing stress on the joint. Dietary counseling and weight reduction for patients with a BMI greater than 25 can significantly decrease hip pain 3,16,21-23. New guidelines from the National Institute for Health and Care Excellence16 recommend an exercise program and physical activity as a priority over medication administration for chronic pain.…”

Section: Managementmentioning

confidence: 99%

“…15 Patients may describe hip pain as acute, chronic primary pain (CPP), or chronic secondary pain (CSP). 16 An example of acute pain is a fractured hip; CPP, pain from a primary source after 3 months such as osteoarthritis; CSP, pain that originates from another source such as rheumatoid arthritis. 16 Physical activity can play a major role in hip disorders and pain.…”

Section: Health Historymentioning

confidence: 99%

See 3 more Smart Citations

Caring for adults with hip pain

Munger

Moore

Kearns

et al. 2022

Nursing

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Section: Managementmentioning

confidence: 99%

Section: Health Historymentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Health Historymentioning

confidence: 99%

See 2 more Smart Citations

Caring for adults with hip pain

Munger

Moore

Kearns

et al. 2022

Nursing

View full text Add to dashboard Cite

show abstract

“… 8 For example, the guidance separates psychological intervention from physical intervention, despite these being used in conjunction in PMPs, and presents an oversimplified definition of pain itself and a ‘one-size-fits-all’ approach, which undermines the unique impacts and treatment demands of individual pain conditions. 9 The Faculty of Pain Medicine 10 has expressed concerns that the guidance poses a risk to the commissioning of PMPs, along with the potential withdrawal of useful treatments and interventions (including PMPs and medications such as non-steroidal anti-inflammatory drugs) from patients in need of these very interventions. The British Pain Society 11 have also commented on the risk of marginalisation and stigma of those experiencing chronic pain is increased through the recommendation of ‘antidepressants’, and the fostering of patient passivity by excluding interventions that empower patients to live well with pain from the recommendations.…”

Section: Introductionmentioning

confidence: 99%

Assessment of suitable referral, effectiveness and long-term outcomes of standard vs intensive pain management programmes for people with chronic pain

Hearn

Martin

Smith

2022

British Journal of Pain

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Background Chronic pain is a leading cause of disability, often requiring multidisciplinary management. 2021 NICE guidance has questioned the quality of the evidence surrounding the efficacy of pain management programmes (PMPs), with only minor benefit demonstrated in psychological and physical outcomes. There is need for further high-quality evidence for the efficacy of PMPs for a range of chronic pain conditions and to identify barriers to successful management of chronic pain. Objective This service evaluation utilised routinely collected outcome data of 508 PMP attendees to investigate change in pain- and patient-related outcomes across two distinct PMPs; a standard and an intensive PMP, and establish their longer-term efficacy and appropriateness for patients with differing degrees of need. Results More people with chronic widespread pain, fibromyalgia, and osteoarthritis were referred to the intensive PMP (reflecting greater disability and distress in these conditions). Those referred to the intensive PMP demonstrated greater distress (such as more severe depression and anxiety), lower pain acceptance and poorer physical function. Improvements were observed in all outcomes across both PMPs (including physical function, pain catastrophising and pain acceptance). Depression and disability demonstrated clinically meaningful improvements in the intensive PMP, and pain severity showed clinically meaningful improvement in both PMPs. However, depression severity, disability, pain severity, and pain interference significantly deteriorated at 6-month follow-up for those on the intensive PMP, with pain severity increasing to a clinically meaningful degree (by more than 10%), though these outcomes remained better than at baseline. Conclusion This evaluation identified that people with chronic pain most at risk of deterioration in physical and psychological wellbeing after completing a PMP require early identification to mitigate such deterioration. Established and emerging PMPs need to be tailored to the needs of this group, particularly at follow-up to reduce risks of pain severity increasing, alongside establishing/reinforcing safeguards against deterioration post-PMP.

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Diagnosis and treatment of meralgia paresthetica between 2005 and 2018: a national cohort study

et al. 2023

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The prevalence of meralgia paresthetica (MP), which is caused by compression of the lateral femoral cutaneous nerve (LFCN), has been increasing over recent decades. Since guidelines and large-scale studies are lacking, there are substantial regional differences in diagnostics and management in MP care. Our study aims to report on current diagnostic and therapeutic strategies as well as time trends in clinical MP management in Germany. Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with MP as their primary diagnosis were identified using the International Classification of Disease (ICD-10) code G57.1 and standardized operations and procedures codes (OPS). A total of 5828 patients with MP were included. The rate of imaging studies increased from 44% in 2005 to 79% in 2018 (p < 0.001) and that of non-imaging diagnostic studies from 70 to 93% (p < 0.001). Among non-imaging diagnostics, the rates of evoked potentials and neurography increased from 20%/16% in 2005 to 36%/23% in 2018 (p < 0.001, respectively). Rates of surgical procedures for MP decreased from 53 to 37% (p < 0.001), while rates of non-surgical procedures increased from 23 to 30% (p < 0.001). The most frequent surgical interventions were decompressive procedures at a mean annual rate of 29% (± 5) throughout the study period, compared to a mean annual rate of 5% (± 2) for nerve transection procedures. Between 2005 and 2018, in-hospital MP care in Germany underwent significant changes. The rates of imaging, evoked potentials, neurography, and non-surgical management increased. The decompression of the LFCN was substantially more frequent than that of the LFCN transection, yet both types of intervention showed a substantial decrease in in-hospital prevalence over time.

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Not really nice: a commentary on the recent version of NICE guidelines [NG193: chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain] by the Pain Net

Abstract: The National Institute for Health and Care Excellence provides evidence-based advice that guides clinical practice. We highlight major criticisms related to the new guideline for chronic primary pain.

Cited by 31 publications

References 12 publications

Caring for adults with hip pain

Caring for adults with hip pain

Assessment of suitable referral, effectiveness and long-term outcomes of standard vs intensive pain management programmes for people with chronic pain

Diagnosis and treatment of meralgia paresthetica between 2005 and 2018: a national cohort study

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