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Wednesday, 13 April 2016

If you suffer chronic pain conventional doctors have nothing safe or effective to offer

New draft NICE guidelines for chronic back pain is discouraging the use of Paracetamol. Doctors are being told that they should review anyone taking this drug as it is not effective in treating the condition. No so evident in the guidance is another important reason for the guidance. Paracetamol is not safe, and certainly not the safe drug doctors told us it was until comparatively recently.

Frustrated doctors are saying this is putting them between 'a rock' and 'a hard place'!  As one doctor says,

          "Paracetamol is a no-no, apparently - though try telling that the the thousands who self-medicate".

So 'the rock' is paracetamol. The 'hard place' is the decades of conventional medical advice to take the drug, as it was considered both safe and effective. Indeed, so safe and effective were we told paracetamol was it is now readily and cheaply available without prescription. And patients know of nothing else.

Yet this is not the only problem, as the same doctor tells us.

          "...if NSAIDs don't help, it's co-codamol, but that's only for three days, of course (says so on the box), so after that, you're on your own, mate."

So doctors have little else to offer chronic back pain sufferers. The doctor's magazine, Pulse, further explains the dilemma now faced by conventional medicine.

           "The draft guidelines, which are currently out for consultation, are set to dramatically shrink the drug options available to GPs in general - and will mean they can no longer prescribe paracetamol on its own. Instead they can consider cocodamol or another combination of paracetamol and ‘weak’ opioid as a second line option for acute episodes, if patients cannot take an NSAID or find they do not work."

The doctor who has written the draft guidelines, Dr Bernstein, is quoted as sayings that the urgency does not concern the safety of the drug itself. Yet the dangers of paracetamol are now well know by the conventional medical establishment (although not by patients), and if it were just a matter of the drug being 'ineffective' the new guidance would surely not have been put forward with such urgency.

So what are doctors doing? It would appear that they are prescribing 20% more 'strong opioids' drugs. As another Pulse article says, a new analysis has shown "that the number of strong opioid analgesics capsules prescribed by GPs , including buprenorphine, fentanyl, morphine and oxycodone, increased by 10% from 2014 to 2015, continuing a trend seen the year before when it rose by 12%".

The article goes on to say that "this increase comes after GPs were told they may soon be barred from prescribing strong opioids for low back pain under planned changes to NICE guidelines".

These are dark days for conventional medicine. Let's be clear, this is not just a problem for those with chronic back pain. The situation is similar for anyone who suffers long-term pain conditions. One doctor, who specialises in the treatment of pain, suggested in the article that there should still be room to prescribe paracetamol on a short-term basis, even though the evidence for it is weak. And he also suggests that there is an issue with the alternative suggestion for treatment contained in the guidelines because of the increasing pressure on .... doctors not to prescribe opioids. He continues,

          "It is difficult to know what GPs are able to prescribe..."!

Difficult indeed, as I said in an earlier blog, the drug cupboard is bare! Doctors are being told regularly that painkilling drugs are not safe. And doctors are having to come to terms with the fact that the drugs they have been giving patients for decades are dangerous. Something of the darkness  facing doctors can be seen from the comments made in response to the Pulse article.

          "Would be great if these suggested other options existed on the NHS. Patients are only going to ask for what is free. If you recommend yoga classes and no meds they will only see other GP or go to OOH of A&E and get paracetamol as well as NSAIDs, benzodiazepine and TCA to follow up with own gp to continue!!!"

          "NICE & Dr. Bernstein may well be right that there's no point in prescribing paracetamol for ANY moderate to severe chronic pain BUT, if the patient cannot tolerate NSAIDs, OR codeine then what else do they suggest since the withdrawal of coproxamol???"

          "I thought the latest current guidelines didn't recommend codiene, benzos, acupuncture or nsaids. Do we just refuse to see/treat backache? I could refer to physiotherapy but there is a more than 12 week wait".

          "Dear Dr Berstein - please get real- GPs have alot on their plate - unless u get NHSE to make it a DES, nobody will even think about it, just shut up as GPs have many many many other priorities."

          "mmmm sounds like good advice. The next 18 stone six foot six self employed brick layer I see with back pain I will advise to take up yoga rather than spend 25p on some painkillers from the supermarket.  I'm so glad NICE are making recommendations that are so applicable to the real World, because other wise we might think they were out of touch academics who hadn't seen a real patient since their last job as a houseman."

          "Of course - go straight to addictive opiates with massive side effects, why didn't I think if that! With a 3-4 month wait for Physio, no access to osteopaths/chiropractors, there should be plenty of time to establish addictions to occupy the time of local drug and alcohol services and of course GPs, as we have nothing to do. I frequently wonder why I completed a medical degree, I should just have read the Daily Mail and joined NICE."

          "NICE lost the plot a long time ago."

It is not so much NICE that has lost the plot. These doctors appear distressed, and are blaming the messenger for the message, which is loud and clear. It is the conventional medical establishment that is losing the plot. The NICE guidance is given to protect the patient from dangerous drugs, yet doctors respond by prescribing even more dangerous drugs, and intent on disregarding the guidance.

But most important of all, it is a matter of concern that so many patients are not aware that there are safer and more effective alternatives to pharmaceutical drugs!