Navigation

Summary of guidance relevant to general practice in May 2012

Opioids for pain relief in palliative care

Opioids should be prescribed to help relieve pain in patients receiving palliative care for chronic or incurable illnesses, says NICE.

For many people with cancer, heart failure or other chronic or neurodegenerative conditions, strong opioids like morphine are the only adequate source of pain relief.

However, evidence suggests that pain caused by advanced disease remains under-treated despite a range of opioids being recommended for use on the NHS.

Some healthcare professionals have reservations about prescribing strong opioids, and many patients worry about the long-term use of opioids, their side-effects and the possibility of becoming addicted.

This latest guidance aims to ensure safe and consistent prescribing of opioids as a first-line treatment option to relieve pain for patients receiving palliative care.

NICE recommends that when offering patients pain treatment with strong opioids, healthcare professionals should discuss any possible concerns such as: addiction, tolerance, side effects, fears that treatment implies the final stages of life.

Patients should be offered access to frequent review of pain control and side effects and information on who to contact out of hours, particularly during initiation of treatment.

When starting treatment with strong opioids, healthcare professionals should offer patients with advanced and progressive disease regular oral sustained-release or immediate-release preparations, with rescue doses of oral immediate-release preparations for breakthrough pain.

Oral sustained-release morphine is recommended as the 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.

Support tools to help you put this guidance into practice

NICE has produced a suite of support tools to help you follow this guidance which features a baseline assessment tool, clinical audit tools, a costing report and template, and a podcast with Mike Bennett, a Professor in Palliative Medicine at Leeds Institute of Health Sciences and member on the guideline development group, on the evidence behind the guideline recommendations.

Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation

Patients with atrial fibrillation can now be offered rivaroxaban (Xarelto), as an alternative to warfarin, in order to reduce their risk of stroke and blood clots, says NICE.

The advice comes just two months after NICE also approved dabigatran for the same condition.

Atrial fibrillation (AF) is a condition that affects the heart causing it to beat irregularly, and occasionally, too fast. When this happens, the heart cannot pump blood around the body efficiently.

People with AF are at higher risk of developing blood clots and subsequent stroke. The risk of stroke can be significantly reduced by using anticoagulants such as warfarin.

While warfarin is typically used for preventing strokes, some patients can find it inconvenient due to the careful monitoring and regular blood tests required to ensure that their blood clotting properties remain within normal limits..

Rivaroxaban is an anticoagulant that is taken orally. It stops a substance called Factor Xa from working, which is necessary for the formation of thrombin and fibrin - key components in the formation of blood clots.

In final guidance published today, NICE recommends rivaroxaban for people with nonvalvular atrial fibrillation, who have one or more risk factors.

These include congestive heart failure, hypertension, if they are aged 75 years or older, have diabetes mellitus, or have had prior stroke or transient ischaemic attack.

Decisions on whether to start treatment with the drug should be made following an informed discussion between the clinician and the patient regarding the risks and benefits of rivaroxaban in comparison with warfarin.

NICE also says that people who are currently taking warfarin should consider the potential risks and benefits of switching to rivaroxaban in light of their international normalised ratio control.

Support tools to help you put this guidance into practice

NICE has developed a clinical audit tool for this guidance.

23 May 2012

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.