This guideline covers safe and effective prescribing of strong opioids for pain relief in adults with advanced and progressive disease. It aims to clarify the clinical pathway for prescribing and help to improve pain management and patient safety. Care during the last 2 to 3 days of life is covered by NICE's guideline on care of dying adults in the last days of life.
In August 2016, recommendation 1.1.12 was deleted and a link added to NICE’s guideline on controlled drugs: safe use and management, which has newer advice on the topic. Two out of date recommendations for research have also been deleted.
This guideline includes recommendations on:
- starting strong opioids and titrating the dose
- first-line maintenance treatment
- first-line treatment using transdermal patches or subcutaneous delivery, if oral opioids are not suitable
- first-line treatment for breakthrough pain in patients who can take oral opioids
- managing constipation, nausea and drowsiness.
Who is it for?
- Healthcare professionals
- People who are taking or being offered strong opioids and their families and carers
Is this guideline up to date?
We reviewed the evidence in July 2016. We identified no major studies that will affect the recommendations in the next 3 to 5 years.
Guideline development process
This guideline was previously called opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.