Table 2.

Summary of some of the recommendations for chronic pain management made in the SIGN guideline.[77] Reproduced from “Managing chronic pain in the non- specialist setting: A new SIGN guideline”

Area addressed by key question	Summary of key recommendations	Level of evidence**
Assessment and planning of care	In order to best direct treatment options, a comprehensive biopsychosocial assessment, including identification of pain type (e.g. neuropathic) should be carried out in any patient with chronic pain.	GPP
Supported self-management	Self-management can be used from an early stage in a pain condition, with patients being directed to self-help resources at any stage in the patient journey.	GPP
Pharmacological therapies	There should be at least annual assessment of patients on pharmacotherapy for chronic pain.	GPP
	Tricyclic antidepressants should not be used for the management of pain in patients with chronic low back pain.	A
	Amitriptyline (25 to 125 mg/day) should be considered for the treatment of patients with fibromyalgia and neuropathic pain (excluding HIV-related neuropathic pain).	A
	Strong opioids should be considered for chronic low back pain or osteoarthritis and only continued if there is ongoing pain relief.	B
	Specialist advice or referral should be considered if there are concerns about rapid opioid dose elevation or if >180 mg/day morphine equivalent dose is needed	D
Psychologically based interventions	Consideration should be given for referral to a pain management programme for patients with chronic pain	C
	There should be an awareness of the impact of healthcare workers behaviour, as well as the treatment environment, in reinforcing unhelpful responses.	GPP
Physical therapies	Any form of exercise or exercise is recommended in for patients with chronic pain.	B
	In addition to exercise therapy, advice to stay active should be given to patients with chronic low back pain. This will improve disability in the long term. Advice alone is insufficient.	A
Complementary therapies	Acupuncture should be considered for short term relief of pain in patients with chronic low back pain or osteoarthritis.	A

^aThis is not a comprehensive list. In total, 55 graded Recommendations are included in the Guideline

^bThe grade of recommendation relates to the strength of the supporting evidence on which the evidence is based. It does not reflect the clinical importance of the recommendation. Grade A is strongest; Grade D weakest; Good practice points (GPP) represent recommended best practice based on the clinical experience of the guideline development group

Reproduced by permission of the British Journal of General Practice. Smith BH, Hardman JD, Stein A, et al. Managing chronic pain in the non-specialist setting: a new SIGN guideline. Br J Gen Pract 2014; DOI: 10.3399/bjgp14X680737