According to NICE guidelines, the recommended first-line pharmacological treatment for chronic primary pain in adults is an antidepressant, such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline, after a full discussion of benefits and harms NICE NG193.
Non-pharmacological treatments are preferred, and medicines such as NSAIDs, opioids, paracetamol, antiepileptic drugs including gabapentinoids, antipsychotics, benzodiazepines, corticosteroid trigger point injections, ketamine, and local anaesthetics are not recommended as first-line treatments for chronic primary pain NICE NG193.
If a person is already taking any of these medicines, review the prescribing as part of shared decision-making, explaining the lack of evidence for their use in chronic primary pain and considering safe discontinuation if appropriate NICE NG193.