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New chronic pain guideline for Scotland

People on painkillers for chronic pain should have at least an annual review of their medication to ensure they are being given the best drugs to treat their condition, according to new advice to be issued to GPs and other healthcare professionals.

The recommendations – issued by the Scottish Intercollegiate Guidelines Network (SIGN), which is part of Healthcare Improvement Scotland – also calls for patients to be encouraged to take regular exercise and to attend pain management programmes to help manage their conditions.

Pain Concern played an important role in representing the views of people in pain at the consultation stage and our chair Heather Wallace reviewed the booklet for patients and carers. Heather said: ‘I hope people living with pain will use this booklet to become more aware of the treatment they are entitled to receive and to empower them in their appointments with healthcare professionals.’

The guideline’s key recommendations include:

• Ensuring all patients with chronic pain undergo a comprehensive assessment to help inform the best treatment options
• Directing patients to the best self-help advice and information resources that they can access either from home or at community health centres
• Conducting 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
• Regularly reviewing the use of strong opioid medications – such as morphine – to treat patients with chronic low back pain or osteoarthritis; and securing specialist advice if there are concerns about patients having no pain relief despite increased medication doses.
• Referring patients with chronic pain to undertake a pain management programme
• Encouraging patients to be active and to try out all forms of exercise and exercise therapies

Dr Lesley Colvin, who chaired the Guideline Development Group, said the recommendations should play a major part in helping patients whose lives are blighted by ongoing pain.

She said: “The recommendations recognise that the best person to both understand chronic pain and to work to find ways to manage it, is the patient.

“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 GPs and 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.”

Each of Scotland’s NHS Boards will now be encouraged to fully share and implement the recommendations from the Guideline working through dedicated Service Improvement Groups in their local communities.

To read the patient booklet and for the full guideline, go to

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