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Chronic pain (analgesia armageddon)
  1. James A Cave, Editor-in-Chief
  1. The Downland Practice, Berkshire, UK
  1. Correspondence to Dr James A Cave, The Downland Practice, Berkshire, UK; jcave{at}

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There is no medical intervention, pharmacological or non-pharmacological that is helpful for more than a minority of people with chronic pain and benefits of treatments are modest in terms of effect size and duration.”1

Such is the starting point for the National Institute for Health and Care Excellence’s (NICE) scoping document for its draft guideline on the management of chronic pain (“pain that persists or recurs for longer than 3 months”) in those aged over 16 years, published in August this year.1 2 The guidance has caused considerable disquiet among clinicians and patient groups alike as it seems to throw all but one pharmacological option onto the bonfire of ineffectiveness. To be absolutely clear, in its draft guidance NICE does not advise the use of opioids, non-steroidal anti-inflammatory drugs (by any route), benzodiazepines, anti-epileptic drugs including gabapentinoids, local anaesthetics, ketamine, corticosteroids, antipsychotics …

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  • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

  • Provenance and peer review Commissioned; externally peer reviewed.