Response to a Petition Against the NICE guidelines

Okay so I’m going to acknowledge that this blog post might be a little divisive. But if I look around at our society right now, most issues regarding health are. This is probably more of an opinion piece than many of my posts, which I do research (yes, I read scientific journal articles to make sure I get the facts as straight as possible for all of you). I did a post (and a podcast episode) about the guidelines that came from NICE in the UK regarding the treatment of chronic pain awhile back. These guidelines were controversial within the medical community itself because, well, they recommend against the use of pain medications due to a lack of evidence that they are effective AND that many of them can be addictive. Doctors, of course, like to prescribe medications.

The recommendations for the treatment were: (1) exercise, (2) acupuncture, (3) cognitive behavioural therapy, (4) acceptance and commitment therapy, and (5) anti-depressants. I recently saw a post on Instagram that linked a petition against these guidelines. The reasoning behind the petition was that it makes it harder for people to get the treatment (i.e., medications) that they need to manage their chronic pain. Much like doctors, most patients also feel like medications are the way to go (which is a fairly western version of pain management – check out the podcast episode with Dr. Richard Harris for an East meets West version of pain management that tends to work better). Now, I’m not saying that pain medication doesn’t work for anyone ever. And I don’t think that’s what they guidelines are saying either. They are saying that the evidence-base isn’t strong for most of those medications, but it is strong for these alternative treatments. The other argument in the petition is that the alternative treatments are expensive and not covered by insurance. I’m going to break each of these arguments down a bit further.

Me during a hike this summer.

So first, whether or not people will still be able to access pain medications. Regardless of these guidelines I find it very hard to believe that most Western doctors will stop prescribing pain medications. Like I mentioned earlier, most doctors were upset by the guidelines in the first place. Also, doctors are trained to prescribe medications, they aren’t trained (literally almost no training) on prescribing alternative treatments. It’s more than likely they’ll go with what they know. They might though be more willing to recommend alternatives as adjunct treatments. This is actually what my rheumatologist did. She recommended that in addition to the medications she prescribed, I seek out alternative treatments such as physiotherapy and naturopathy (and I did and they were helpful). I get why people are upset about the guidelines, especially if they mostly rely on medications. The guidelines do state that for some conditions (mostly CRPS) pain medications do work best (it’s best just to read all the guidelines – AND all the hyperlinks that give fuller explanations yourself – available here).

The second point that alternative treatments are expensive, is true and not true at the same time. Exercise is technically free. I exercise at home – both cardio (walking) and strength training (body weight) and have spent $0 on it since the pandemic started (I did go to the gym before that). But a lot of people with chronic pain are hesitant about exercising (check out the podcast episode with Dr. Frank Nahn). Acupuncture can be a bit pricey depending on where you live, but it is sometimes covered by insurance. I had insurance through work that covered my naturopath, who did acupuncture, for up to $500 a year. That’s about 6 sessions. I’m not saying it’s always covered, but it might be. CBT and ACT, the two psychotherapies listed are along the same lines as acupuncture. They might be covered or they might not be. In the province (Canada) that I live, it is covered up to a certain amount by provincial insurance, or short-term therapy is also covered by the provincial government. There are also self-help versions of these available at bookstores and online. Finally, anti-depressants, again may be covered by extended health insurance if you have that. Also, wouldn’t a better petition to be to try and get governments (or insurance companies) to cover these services for chronic pain and chronic illness patients? Just a suggestion…

As a therapist who went into the field to help people with chronic pain and illness (and their co-occurring mental health issues I decided to primarily use ACT with my clients due to its large evidence base).

I guess what I’m saying is that if you dislike the guidelines because you only rely on medication but also haven’t tried or even looked into these alternatives, then it makes sense that you’d be upset. I would be too! I started using some of these alternatives (exercise, acupuncture, CBT/ACT) long before these guidelines came out and I saw how much they improved my well-being, well over and beyond what my medication has ever done. I also find it interesting that I often see posted online people complaining that their medications aren’t really helping. It’s easy to have some cognitive dissonance here. We want to believe medications will solve all our problems even when we’re acknowledging that they’re not. I’m doubtful that I’ll change too many minds with this post, but my hope is that we at least get thinking about using both holistic approaches (like in NICE’s guidelines) and are medication together so that we can get the best results.

Okay, that is all for this week. Keep making the most of it everyone!

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