Paracetamol and NSAIDs do more harm than good (NICE Guidelines, 2020)

Last night, an acquaintance from Oxford said to me, “You seem to store a lot of faith in academia.”

Yes, I do.

I do put a lot of faith in science and research because I think it is the best way to understand problems and, more importantly, to find solutions.

You would be totally right in that science doesn’t have all the answers. In fact, you would also be right in saying that science does get things wrong.

Yet at the same time it should also be remembered that it is science who corrects such mistakes.

While science and research may not have all the answers, it has the most correct version of the know

ledge as we know it at any give time.

chronic pain, panadol singapore, ibuprofen singapore

Just a couple of days ago, the British National Institute for Health and Care Excellence (NICE) released their draft guideline for chronic pain.

What makes this draft guideline exciting is that the guideline specifically calls out paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen as being useless when it comes to chronic pain.

So if you have been taking Panadol or Nurofen of similar drugs for your pain management, you may want to pay attention to this space.

The final guidelines wouldn’t be published until much later. It is currently open for public consultation from now until 14 September 2020.

Exercise for chronic pain

pain solutions, stress, injury, chiropractor singapore
Greg Lehmans cup analogy explains why exercise can help with pain Exercise makes your cup bigger This means your body will be more resilient against stressors such as stress injuries fear and even anxiety Talk about multiple birds with one stone

It should come as no surprise but exercise remains the first line treatment for chronic pain.

If you are suffering from chronic back pain, neck aches, or anything in between, NICE is saying exercise is likely to help.

I do understand that exercising for pain patients may not sound intuitive. You may even be worried about making your pain or injury worse.

This is why I take a problem-solving approach to helping my clients. No cookie cutter approach. The exercises you do receive under my care is specific to your condition and your current condition.

This is also in accordance to the draft guideline’s recommendation: “take people’s specific needs, preferences and abilities into account.”

Psychological therapy

compassion-focused therapy, cbt, cognitive behavioural therapyI haven’t made any public announcement yet but I am back at university to pursue another (my third) degree. This time round I am studying psychology.

The reason is simple: Exercise-alone is not holistic enough to help my clients find freedom from pain.

While I have introduced coaching principles into my work, further studies in psychology will enable me to further empower my clients.

According to the guidelines, Acceptance and Commitment Therapy (ACT) or Cognitive Behavioural Therapy (CBT) can both be considered for chronic pain sufferers.

Manual therapy

neck pain, jesse cai, chiropractor singapore
There was some misconception that I never did adjustments I did Ive adjusted everybody from local celebrities to professional athletes However I decided to stopped offering completely because I <a href=httpschiropractor singaporecomsgresourcescoaching based chronic pain solution singapore>wanted to deliver better results<a>

Manual therapy is an umbrella term to cover all hands-on treatments from chiropractic adjustments to massage.

It should come as NO surprise. that the guideline specifically highlighted that there was not enough evidence on manual therapy to support its efficacy for chronic pain.

If you have been going to a chiropractor who cracks your spine like a light stick or a physiotherapists who does lots of soft tissue/IASTM work AND you are not getting better, you really should consider more evidence-based alternatives.

chiropractic treatment

Quite often we choose treatments based on our own beliefs and what makes sense to us, but what if these beliefs are false?

From a research-based viewpoint, it makes total sense why you are not getting better with such treatments.

The question is how can I convince you that what I do does deliver better results?

TENS and ultrasound

ultrasound, tens, knee pain
Some companies are great at making pretty graphics and telling convincing stories on why their treatments work However NICE guideline is clear on that TENS and ultrasound treatment SHOULD NOT be offered to clients with chronic pain

Don’t even get me started on this!

I’ve mentioned both modalities in my post on hip and knee osteoarthritis. They don’t work!

NICE guideline is very clear on that it doesn’t work. In their words:

Do not offer TENS, ultrasound, or interferential therapy for chronic pain. 

Like, DO NOT.

I know some chiropractors TENS and ultrasound so they can prolong their treatment duration. It will look like the patients are getting more out of their time at the clinic but really what is happening is that they are wasting their patients’ time and money.

Pain medication

Also another “DO NOT” from the guideline.

Yes, the opioid crisis is big in the western world but that doesn’t mean Singapore is safe okay?

Most people would self-medicate when they experience pain. But guess what? It doesn’t work.

NICE says DO NOT offer NSAIDs (anti-inflammatories) and paracetamol for chronic pain.


Why does medication and manual therapy not work for chronic pain?

The truth is we don’t really know why they don’t work.

What we do know is that chronic pain (pain that persists or recurs for more than three months) is multifactorial in nature.

This means it’s not just something is wrong with your body or that you are injured or that you have bad posture.

It’s more than that!

There are also psychological and social contributors that medication and manual therapy cannot address.

To some extent you could also say that exercise is a physical activity so it only affects the body.

It makes sense when you put it that way but exercise has more effects/benefits than we currently understand.

For example, we do know that exercise helps reduce symptoms in patients with depression and anxiety.

For example, we do know that regular exercise is a behavioural/lifestyle change.

We actually do know exercise affects more than just the physical body.

If you are living with persistent or recurring pain for over three months and you just simply don’t seem to be getting better, seek out an evidence-based practitioner to help you get through this challenging period. I love science and research because it tells us what is most likely to work and what is most likely to help you get better. This is why over 80% of my clients achieve their recovery goals in over four to seven visits. If you would like discover the difference the right care can make, book in an appointment with me via the form below!


Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.