Science Photo Library/Alamy Stock Photo
People living with chronic pain — and their healthcare team — should consider non-pharmacological approaches as a first step in pain management, according to new guidance from the Scottish government.
The guidance, published by the Scottish government on 24 March 2026, has emphasised the need for a person-centred, biopsychosocial approach to pain management that takes into account people’s background, beliefs, fears and expectations, as well as the causes of their pain.
“Chronic pain is a long-term condition. It cannot be ‘fixed’ or managed in an initial ten-minute consultation often when an individual is in crisis and distressed,” it said.
“To reduce clinician stress and have a more effective consultation, it helps to instead focus on listening to the individual’s story, validating and building trust.”
According to the results of the ‘Scottish health survey 2022‘, more than one-third (38%, n=4,394) of adults in Scotland reported chronic pain that persisted for more than three months.
The guidance also pointed out that biopsychosocial effects play a significant role in chronic pain management, citing the results of a 2019 Cochrane review that showed that, while 300mg pregabalin daily reduced pain intensity by 30% in 47% of patients, 42% of patients taking a placebo experienced similar pain reduction.
The guidance added: “High-quality evidence for individual non-pharmacological approaches is limited, due to the challenge of blinding interventions, variation between individuals and multiple presentations of chronic pain.”
However, it said: “There are many good practice interventions that may provide benefit based on practitioner and individual experience, and limited evidence.”
The Scottish government has recommend that clinicians should offer non-pharmacological resources as part of personalised pain management plans, which may also include pharmacological management.
The guidance has also noted that where medicines are accepted by the patient, those taking opioid doses at greater than 50mg morphine equivalent dose (MED) per day should be offered a review at least once per year to “detect emerging harms and consider ongoing effectiveness”.
Where a patient is taking more than 90mg MED per day, the guidance added that advice or a medication review should be sought from a pain specialist.
It has also advised that clinicians should consider prescribing naloxone to patients who have been prescribed an opioid and who may be at risk of an opioid overdose.
Cara Mackenzie, deputy director of pharmacy and medicines at NHS Fife, commented: “NHS Fife welcomes this national guidance, which supports safer, more person centred approaches to managing chronic pain.
“Our ‘Pain Talking’ initiative already reflects these principles by helping people and clinicians work together to understand what matters most and explore the full range of treatment options available.
“We will review the guidance in detail and ensure its recommendations are embedded across our services.”
A spokesperson for the charity Pain Concern told The Pharmaceutical Journal: “This guideline recognises chronic pain as a condition in its own right. In the past clinicians have prescribed powerful medications for chronic pain but drugs don’t always work, they are rarely the only answer and they can cause harm.
“That’s what’s important about this new guide. It adopts a holistic approach bringing together the latest evidence on what medications work best for chronic pain and cause least harm, with explaining what the patient can do for themselves.
“It also emphasises the importance of good communication, allowing an informed and realistic conversation about how we can all work together, as patients and professionals, to improve life with pain. It empowers patients and professionals.”
The Scottish government said the new guidance should be considered alongside ‘Scottish Intercollegiate Guidelines Network (SIGN) 173: Management of chronic pain‘, which also does not recommend the routine use of opioids for chronic pain.
