Scope and methodology

This guide aims to provide a practical resource for practitioners helping people who live with chronic pain. Communication and non-pharmacological approaches are often central to achieving good results for patients, and these are explored in detail. Where medicines are used there should be an optimal balance between therapeutic effects and side effects of the medication, with an emphasis on non-pharmacological approaches.

Chronic pain, defined as persistent pain lasting beyond three months¹, can significantly impact quality of life, affecting physical and mental wellbeing.  In Scotland, the Scottish Health Survey (2022) indicates that approximately 38% of adults live with chronic pain. The prevalence of chronic pain is significantly higher in areas of socioeconomic deprivation.

There is a complex interplay between the social determinants of health and chronic pain, which require carefully considered management to achieve good outcomes. Medication reviews, focusing on what matters to the individual using a person-centred 7-Steps approach, are key to supporting people manage chronic pain and address the factors that influence their health.

With this guidance, we aim to support prescribers navigating the complexities of chronic pain management, particularly given the risks of adverse effects, dependency and the association with polypharmacy.

This guide was developed by the collaborative efforts of a multidisciplinary team of clinicians, academics, experts by experience, patient groups and policy makers from across Scotland, from Scottish Government and NHS Scotland.

This document is intended to support good clinical practice and it is complementary to SIGN 173.

We have provided an indication on the strength of recommendations and guidance, which indicates the type of evidence that the recommendation is based on. The categories follow SIGN guidance terminology, categorising recommendations as strong, conditional or a good practice point.

• Strong: interventions that 'should/should not' be used for most people, based on evidence of high quality.
• Conditional: interventions that should be ‘considered', but the evidence is of low/mixed quality, or there is a risk of harm which should be balanced against the potential benefit.
• Good practice points: generally accepted practice, therefore it is unlikely that research would be conducted to confirm this. These good practice points are supported by the expert writing group.