Abstract
The publication of the public health messages to avert a UK opioid crisis is timely. 1 The National Institute for Health and Care Excellence has recently issued a statement for setting out a plan for the NHS to implement its updated guideline on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).2,3 However, as this needs time and resources, the NHS will struggle to implement. In rheumatology practice, we regularly see patients with fibromyalgia, CFS or hypermobility spectrum disorder who are already taking various forms of opioids for unexplained chronic pain without effective relief. There are hardly any specialist clinics with effective treatment pathways for those patients and others with primary chronic pain syndromes. Educating doctors and patients on an early positive diagnosis of primary chronic pain syndrome and realising the lack of effective benefits from using opioids may prevent the use of these addictive drugs.
The four messages stated by Richards et al. are clear and easy to communicate. 1 Acute and chronic pain are different. Only acute but not chronic pain responds to opioids. The potential serious side effects of opioids must be made clear to patients, and those on high doses may not be fit to drive a motor vehicle.
The NHS is understaffed and under-resourced but an urgent practical plan is needed to address the problems of chronic pain and the unnecessary and harmful use of opioids.