BBC

Doctors are being advised not to prescribe common painkillers, including paracetamol and ibuprofen, for patients with chronic pain not caused by an injury or other medical condition.

The National Institute of Health and Care Excellence (NICE) said there was little evidence they help.

And it suggests there is evidence long-term use can be harmful.

Its draft guidance recommends antidepressants, acupuncture or psychological therapy instead.

… They could also consider recommending a course of cognitive therapy, aimed at helping patients accept their condition or change the way they thought about it.

… The guidelines acknowledged there is a lot of uncertainty in this diagnosis, and “normal or negative test results can be communicated in a way that is perceived as being dismissive of pain”.

When it comes to chronic pain more broadly – defined as pain that “persists or recurs” for more than three months, no matter the cause – NICE advises using these new guidelines alongside existing guidance on the management of specific conditions.

That includes headaches, back pain, arthritis and endometriosis.

A research team has found a small area of the brain in mice that can profoundly control the animals’ sense of pain. Somewhat unexpectedly, this brain center turns pain off, not on. It’s located in an area where few people would have thought to look for an anti-pain center, the amygdala, which is often considered the home of negative emotions and responses, like the fight or flight response and general anxiety.

Somewhat unexpectedly, this brain center turns pain off, not on. It’s also located in an area where few people would have thought to look for an anti-pain center, the amygdala, which is often considered the home of negative emotions and responses, like the fight or flight response and general anxiety.

“People do believe there is a central place to relieve pain, that’s why placebos work,” said senior author Fan Wang, the Morris N. Broad Distinguished Professor of neurobiology in the School of Medicine. “The question is where in the brain is the center that can turn off pain.”

Using a technology called optogenetics, which uses light to activate a small population of cells in the brain, the researchers found they could turn off the self-caring behaviors a mouse exhibits when it feels uncomfortable by activating the CeAga neurons. Paw-licking or face-wiping behaviors were “completely abolished” the moment the light was switched on to activate the anti-pain center.

“It’s so drastic,” Wang said. “They just instantaneously stop licking and rubbing.”

When the scientists dampened the activity of these CeAga neurons, the mice responded as if a temporary insult had become intense or painful again. They also found that low-dose ketamine, an anesthetic drug that allows sensation but blocks pain, activated the CeAga center and wouldn’t work without it.

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