TY - JOUR T1 - Chronic pain (analgesia armageddon) JF - Drug and Therapeutics Bulletin JO - Drug Ther Bull SP - 162 LP - 162 DO - 10.1136/dtb.2020.000054 VL - 58 IS - 11 AU - James A Cave Y1 - 2020/11/01 UR - http://dtb.bmj.com/content/58/11/162.abstract N2 - “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 To be absolutely clear, in its draft guidance NICE does not advise the use of opioids, non-steroidal anti-inflammatory drugs (by any route), benzodiazepines, anti-epileptic drugs including gabapentinoids,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 … ER -