What are the recommended first-line pharmacological treatments for chronic pain management in adults?

For adults with chronic primary pain, NICE recommends considering an antidepressant, such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline, after a full discussion of benefits and harms ¹.

Do not initiate NSAIDs, opioids, or gabapentinoids (including pregabalin) for chronic primary pain, as evidence for their effectiveness is lacking and they may cause harm ¹.

If a person is already taking these medications, review the prescribing and consider stopping if benefits are minimal or harms are significant, following shared decision-making ¹.

Self-management and non-pharmacological approaches are also recommended as part of the management plan ².