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New chronic pain guidance for Scottish clinicians

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Patients taking painkillers for chronic pain should have a review of their medication at least once a year, according to new guidelines published for health professionals in Scotland.

Among its recommendations, the Scottish Intercollegiate Guidelines Network also calls for patients to be encouraged to take regular exercise and to undergo pain management programmes to help manage their conditions.

The SIGN guideline aims to improve awareness and knowledge about the range of treatments available in Scotland for chronic pain – defined as pain that continues for more than 12 weeks, despite treatment.

As part of the guideline, there are pathways to help direct assessment and management in particularly difficult areas, such as neuropathic pain and when to use strong opioids.

Its key recommendations include ensuring all patients with chronic pain undergo a comprehensive assessment to help inform the best treatment options and directing patients to the best self-help information resources they can access from home or at community health centres.

It also advises clinicians to conduct at least an annual review of patient medication to determine the success of a particular drug – more frequently if drug treatments change or pain continues – and calls for regular reviews of the use of strong opioids to treat chronic low back pain or osteoarthritis.

In addition, the guidance recommends referring patients with chronic pain to undertake a pain management programme and encouraging patients to be active and to try out all forms of exercise.

Dr Lesley Colvin, consultant in pain medicine at Edinburgh’s Western General Hospital, who chaired the SIGN guideline development group, said: “Everyone is different – while one particular treatment may work very effectively in one individual, it may not work at all in another.

“As well as the physical sensations of pain, patients also often experience changes in their mood and what they are able to do, impacting on their work, family and friends.

“That is why it is important healthcare professionals use these guidelines to find the best treatments specific to patient and to address their overall condition, rather than just treating the pain itself,” she said.

Each of Scotland’s NHS Boards will now be encouraged to fully share and implement the recommendations from the guideline.

A patient version is also available to provide a resource for those with chronic pain, allowing them to be well informed and actively involved in their treatment choices.

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