Surveillance decision

Surveillance decision

We will not update the guideline at this time.

We will amend the guideline to replace recommendation 1.1.12 about opioid equivalence for transdermal patches with a cross-reference to the more recent guidance in 'Controlled drugs: safe use and management (2016) NICE guideline NG46'.

We will transfer the guideline to the static list because:

  • No evidence was identified that would impact on the current guidance and no major ongoing research has been identified as due to be published in the near future (that is, within the next 3–5 years).

Reason for the decision

We found 35 new studies through surveillance of this guideline.

This included new evidence that supports current recommendations, including:

  • communication with patients and their carers

  • titrating the starting dose of strong opioids

  • first-line maintenance treatment

  • first-line treatment if oral opioids are not suitable (transdermal patches)

  • first-line treatment for breakthrough pain in patients who can take oral opioids

  • management of constipation.

We did not find any new evidence on subcutaneous delivery as first-line treatment if oral opioids are not suitable, management of nausea, or management of drowsiness.

None of the new evidence considered in surveillance of this guideline was thought to have an effect on current recommendations.

In addition, no major ongoing studies or research due to be published in the next 3–5 years was identified.

Other clinical areas

We did not find any new evidence in areas not covered by the original guideline.

For any new evidence relating to published or ongoing NICE technology appraisals, the guideline surveillance review deferred to the technology appraisal decision.


No equalities issues were identified during the surveillance process.

Overall decision

After considering all the new evidence and views of topic experts and stakeholders, we decided that no update is necessary for this guideline.

See how we made the decision for further information.

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