NICE consults on draft recommendations on the use of opioids in palliative care
NICE, the healthcare guidance body, is currently developing a new short clinical guideline on the safe and effective prescribing of strong opioids in palliative care. As part of this process, draft recommendations have been published on the NICE website today (2 December) for public consultation.
Commenting on the draft recommendations Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: "Many people with advanced or progressive conditions such as cancer or chronic illness such as kidney, liver and respiratory disease will experience high levels of pain. When weaker pain relief is no longer effective, strong opioids such as morphine are usually introduced. However, we know that many people worry about becoming addicted to this strong medication and have concerns about side effects. They also worry about focusing on pain relief rather than treating the underlying disease.
"The new draft guideline puts a strong emphasis on good communication between patient and healthcare professionals. This is key to ensuring that any doubts or uncertainties are addressed, thereby enabling the patient to feel content in following what has been prescribed and therefore potentially improving their pain control and reducing any associated side effects.
"We are inviting anyone who has experience with palliative care and pain relief with opioids, including healthcare professionals, charities and members of the public, to comment on our draft recommendations via one of our registered stakeholders. This is so that we can ensure the final version of our clinical guideline is of greatest benefit to the NHS and importantly to those who live with this condition."
In its draft clinical guideline, NICE advises that:
Communication: When offering a patient pain treatment with strong opioids, ask them about concerns such as: addiction, tolerance, side effects, fears that treatment implies the final stages of life.
Offer patients access to frequent review of pain control and side effects and information on who to contact out of hours, particularly during initiation of treatment.
First-line treatment: When starting treatment with strong opioids, offer patients with advanced and progressive disease regular oral sustained-release or immediate-release preparations (depending on patient preference and clinical presentation), with rescue doses of oral immediate-release preparations for breakthrough pain.
First-line maintenance therapy: Offer oral sustained-release morphine as first-line maintenance therapy to patients with advanced and progressive disease who require strong opioids. If pain remains uncontrolled despite optimising first-line therapy, review analgesic strategy and consider seeking specialist advice.
Management of nausea: Advise patients that nausea may occur when starting opioid therapy or at dose increase, but that it is likely to be transient.
Management of drowsiness: Advise patients that mild drowsiness or impaired concentration may occur when starting opioid therapy or at dose increase, but that it is often transient.
Notes to Editors
About the clinical guideline
1. The draft recommendations will be available on the NICE website from 2 December 2011 to 6 January 2012 at http://guidance.nice.org.uk/CG/Wave24/4.
2. A number of strong opioids are licensed in the UK, however for pain relief in palliative care a relatively small number are is commonly used. This guideline has therefore looked at the following drugs: buprenorphine, diamorphine, fentanyl, morphine and oxycodone. The guideline does not make recommendations on drug dosage
3. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health
4. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
5. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
6. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
This page was last updated: 01 December 2011