{"text_format":"1","workbook":"xlsx","n_sheets":3,"sheets":["Cover page ","Introduction","Data sheet"],"not_rendered":{"charts":0,"images":2,"macros":0,"external_links":2,"defined_names":187,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Cover page ","index":0,"n_rows":12,"n_cols":1,"rows_kept":12,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
[]
[]
[]
[]
["Baseline assessment: Chronic pain "]
["(primary and secondary) in over 16s: "]
["assessment of all chronic pain and"]
["management of chronic primary pain"]
["NG193"]

{"sheet":"Introduction","index":1,"n_rows":21,"n_cols":1,"rows_kept":21,"cut":false,"hidden":false,"merged":[]}
["Baseline assessment tool for Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NICE guideline NG193)"]
[]
["This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. It can also help to plan activity to meet the recommendations."]
[]
["The tool can be used by individual services or organisations.  Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
[]
["It should be used in conjunction with Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NICE guideline NG193)."]
[]
["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
[]
["Is the guideline relevant?"]
[]
[]
["The Data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
[]
["The table can be adapted to include any other local information that is thought to be useful."]
[]
["If it would be helpful to group the recommendations, for example by deadline, use the Filter function in the Data menu. "]
[]
["Tools and resources to help put the guidance into practice are available on the NICE website. "]
["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2021. All rights reserved. Subject to Notice of rights.\n"]

{"sheet":"Data sheet","index":2,"n_rows":61,"n_cols":10,"rows_kept":61,"cut":false,"hidden":false,"merged":[]}
[{"$f":"Introduction!A1","v":"Baseline assessment tool for Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NICE guideline NG193)"}]
[]
["Number of relevant or partially relevant recommendations",{"$f":"SUMPRODUCT(COUNTIF(C10:C1005,{\"Yes\",\"Partial\"}))","v":0}]
["Number of recommendations met",{"$f":"COUNTIF(E10:E1005,\"Yes\")","v":0}]
["Number of recommendations partially met",{"$f":"COUNTIF(E10:E1005,\"Partial\")","v":0}]
["Percentage of recommendations met",{"$f":"IF(ISERROR(B4/B3),\"\",B4/B3)","v":""}]
["Percentage of recommendations partially met",{"$f":"IF(ISERROR(B5/B3),\"\",B5/B3)","v":""}]
[]
["NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1 Assessing all types of chronic pain (chronic primary pain, chronic secondary pain, or both) "]
["Person-centred assessment"]
["Offer a person-centred assessment to those presenting with chronic pain (chronic primary pain, chronic secondary pain, or both), to identify factors contributing to the pain and how the pain affects the person’s life. ","1.1.1"]
["When assessing and managing any type of chronic pain (chronic primary pain, chronic secondary pain, or both) follow the recommendations in the NICE guideline on patient experience in adult NHS services, particularly relating to:\n•\tknowing the patient as an individual\n•\tenabling patients to actively participate in their care, including:\n      -\tcommunication\n      -\tinformation\n      -\tshared decision making","1.1.2"]
["Foster a collaborative and supportive relationship with the person with chronic pain.","1.1.3"]
["Thinking about possible causes for pain"]
["Think about a diagnosis of chronic primary pain if there is no clear underlying (secondary) cause or the pain or its impact is out of proportion to any observable injury or disease, particularly when the pain is causing significant distress and disability.","1.1.4"]
["Make decisions about the search for any injury or disease that may be causing the pain, and about whether the pain or its impact are out of proportion to any identified injury or disease using clinical judgement in discussion with the person with chronic pain.","1.1.5"]
["Recognise that an initial diagnosis of chronic primary pain may change with time. Re-evaluate the diagnosis if the presentation changes.","1.1.6"]
["Recognise that chronic primary pain can coexist with chronic secondary pain.","1.1.7"]
["Talking about pain – how this affects life and how life affects pain"]
["Ask the person to describe how chronic pain affects their life, and that of their family, carers and significant others, and how aspects of their life may affect their chronic pain. This might include:\n•\tlifestyle and day-to-day activities, including work and sleep disturbance \n•\tphysical and psychological wellbeing\n•\tstressful life events, including previous or current physical or emotional trauma \n•\tcurrent or past history of substance misuse\n•\tsocial interaction and relationships\n•\tdifficulties with employment, housing, income and other social concerns.","1.1.8"]
["Be sensitive to the person’s socioeconomic, cultural and ethnic background, and faith group, and think about how these might influence their symptoms, understanding and choice of management.","1.1.9"]
["Explore a person’s strengths as well as the impact of pain on their life. This might include talking about:\n•\ttheir views on living well\n•\tthe skills they have for managing their pain\n•\twhat helps when their pain is difficult to control.","1.1.10"]
["Ask the person about their understanding of their condition, and that of their family, carers and significant others. This might include:\n•\ttheir understanding of the causes of their pain\n•\ttheir expectations of what might happen in the future in relation to their pain\n•\ttheir understanding of the outcome of possible treatments.","1.1.11"]
["When assessing chronic pain in people aged 16 to 25 years, take into account:\n•\tany age-related differences in presentation of symptoms\n•\tthe impact of the pain on family interactions and dynamics\n•\tthe impact of the pain on education and social and emotional development. ","1.1.12"]
["Recognise that living with pain can be distressing and acknowledge this with the person with chronic pain.","1.1.13"]
["Providing advice and information"]
["Provide advice and information relevant to the person’s individual preferences, at all stages of care, to help them make decisions about managing their condition, including self-management.","1.1.14"]
["Discuss with the person with chronic pain and their family or carers (as appropriate):\n•\tthe likelihood that symptoms will fluctuate over time and that they may have flare-ups\n•\tthe possibility that a reason for the pain (or flare-up) may not be identified\n•\tthe possibility that the pain may not improve or may get worse and may need ongoing management\n•\tthere can be improvements in quality of life even if the pain remains unchanged.","1.1.15"]
["When communicating normal or negative test results, be sensitive to the risk of invalidating the person’s experience of chronic pain.","1.1.16"]
["Developing a care and support plan"]
["Discuss a care and support plan with the person with chronic pain. Explore in the discussions: \n•\ttheir priorities, abilities and goals\n•\twhat they are already doing that is helpful\n•\ttheir preferred approach to treatment and balance of treatments for multiple conditions\n•\tany support needed for young adults (aged 16 to 25) to continue with their education or training, if this is appropriate.","1.1.17"]
["Explain the evidence for possible benefits, risks and uncertainties of all management options when first developing the care and support plan and at all stages of care.","1.1.18"]
["Use these discussions to inform and agree the care and support plan with the person with chronic pain and their family or carers (as appropriate).","1.1.19"]
["Offer management options:\n•\tin line with section 1.2 of this guideline if the assessment suggests the person has chronic primary pain\n•\tin line with the NICE guideline for the underlying chronic pain condition (see the NICE Pathway on chronic pain) if the underlying condition adequately accounts for the pain and its impact. ","1.1.20"]
["When chronic primary pain and chronic secondary pain coexist, use clinical judgement to inform shared decision making about management options in section 1.2 of this guideline and in the NICE guideline for the chronic pain condition.","1.1.21"]
["Flare-ups"]
["Offer a reassessment if a person presents with a change in symptoms such as a flare-up of chronic pain. Be aware that a cause for the flare-up may not be identified.","1.1.22"]
["If a person has a flare-up of chronic pain:\n•\treview the care and support plan\n•\tconsider investigating and managing any new symptoms\n•\tdiscuss what might have contributed to the flare-up (see recommendation 1.1.8 for influences on the experience of pain).","1.1.23"]
["1.2 Managing chronic primary pain"]
["Non-pharmacological management of chronic primary pain"]
["Exercise programmes and physical activity for chronic primary pain"]
["Offer a supervised group exercise programme to people aged 16 years and over to manage chronic primary pain. Take people’s specific needs, preferences and abilities into account.","1.2.1"]
["Encourage people with chronic primary pain to remain physically active for longer-term general health benefits (also see NICE guidelines on physical activity and behaviour change: individual approaches).","1.2.2"]
["Psychological therapy for chronic primary pain"]
["Consider acceptance and commitment therapy (ACT) or cognitive–behavioural therapy (CBT) for pain for people aged 16 years and over with chronic primary pain, delivered by healthcare professionals with appropriate training.","1.2.3"]
["Do not offer biofeedback to people aged 16 years and over to manage chronic primary pain.","1.2.4"]
["Acupuncture for chronic primary pain"]
["Consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system, for people aged 16 years and over to manage chronic primary pain, but only if the course:\n•\tis delivered in a community setting and \n•\tis delivered by a band 7 (equivalent or lower) healthcare professional with appropriate training and\n•\tis made up of no more than 5 hours of healthcare professional time (the number and length of sessions can be adapted within these boundaries) or\n•\tis delivered by another healthcare professional and/or in another setting for equivalent or lower cost.","1.2.5"]
["Electrical physical modalities for chronic primary pain"]
["Do not offer any of the following to people aged 16 years and over to manage chronic primary pain because there is no evidence of benefit:\n•\tTENS\n•\tultrasound\n•\tinterferential therapy.","1.2.6"]
["Pharmacological management of chronic primary pain"]
["Consider an antidepressant, either amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline, for people aged 18 years and over to manage chronic primary pain, after a full discussion of the benefits and harms.  ","1.2.7"]
["Seek specialist advice if pharmacological management with antidepressants is being considered for young people aged 16 to 17 years.","1.2.8"]
["If an antidepressant is offered to manage chronic primary pain, explain that this is because these medicines may help with quality of life, pain, sleep and psychological distress, even in the absence of a diagnosis of depression.","1.2.9"]
["Do not initiate any of the following medicines to manage chronic primary pain in people aged 16 years and over:\n•\tantiepileptic drugs including gabapentinoids, unless gabapentinoids are offered as part of a clinical trial for complex regional pain syndrome (see research recommendation 5)\n•\tantipsychotic drugs \n•\tbenzodiazepines \n•\tcorticosteroid trigger point injections\n•\tketamine\n•\tlocal anaesthetics (topical or intravenous), unless as part of a clinical trial for complex regional pain syndrome (see research recommendation 5)\n•\tlocal anaesthetic/corticosteroid combination trigger point injections\n•\tnon-steroidal anti-inflammatory drugs\n•\topioids\n•\tparacetamol.","1.2.10"]
["If a person with chronic primary pain is already taking any of the medicines in recommendation 1.2.10, review the prescribing as part of shared decision making:\n•\texplain the lack of evidence for these medicines for chronic primary pain and \n•\tagree a shared plan for continuing safely if they report benefit at a safe dose and few harms or\n•\texplain the risks of continuing if they report little benefit or significant harm, and encourage and support them to reduce and stop the medicine if possible.","1.2.11"]
["When making shared decisions about whether to stop antidepressants, opioids, gabapentinoids or benzodiazepines, discuss with the person any problems associated with withdrawal.","1.2.12"]
["For recommendations on stopping or reducing antidepressants, see the NICE guideline on depression in adults.","1.2.13"]
["For recommendations on reviewing treatments, see the NICE guidelines on medicines optimisation and medicines adherence.","1.2.14"]
["For recommendations on cannabis-based medicinal products, including recommendations for research, see the NICE guideline on cannabis-based medicinal products.","1.2.15"]