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NICE calls for better communication on opioid treatment


Nurses should discuss concerns about addiction with patients who are being treated with strong opioids for pain relief when nearing the end of life, according to latest guidance.

The National Institute for Health and Clinical Excellence has published a clinical guideline on prescribing opioids to relieve pain for patients receiving palliative care for chronic or incurable illnesses.

NICE said evidence suggested pain caused by advanced disease remained under-treated, with many patients worried about the long-term use of opioids, their side-effects and the possibility of becoming addicted.

Damien Longson, chair of the development group for this guideline, said: “This guideline puts a strong emphasis on good communication between healthcare professionals and patients, which is key to ensuring any worries or uncertainties are addressed with timely and accurate information.

“This will help the patient to feel content in following what has been prescribed, potentially improving their pain control and reducing any associated side effects.”

The guidance calls on clinicians to ask patients about concerns including addiction, side effects, and fears that treatment implies the final stages of life. Patients should be offered frequent reviews of pain control and side effects, and information on clinicians available for support out of hours.

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

In addition, oral sustained-release morphine should be offered as first-line maintenance therapy to patients with advanced and progressive disease who require strong opioids.

The guideline recommends clinicians prescribe laxative treatment for all patients initiating strong opioids to counter constipation side effects, and advise them that feelings of nausea, mild drowsiness or impaired concentration are likely to be transient.


Readers' comments (4)

  • Thank you for this article. Glad to hear about the guidelines re opoids, having witnessed a patient with OIH and the devastating result. THERE IS AN "END OF LIFE CONFERENCE, 18TH jUNE RSM, LONDON, 2-5PM, NURSES AND DR'S WELCOME. DEATILS AND FORM 02073419086 OR 01244 629072

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  • it cannot always be assumed that patients are at the end of life and morphine doses should be very carefully titrated to avoid patients dying from an overdose or becoming addicted.

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  • Anonymous | 28-May-2012 2:33 pm

    I've scanned that report, and I'm not 100% certain but the phrase 'at the end of life' has to be handled carefully. If I remember correctly, this report specifically excluded 'the very end of life' - it isn't for LCP, but for relatively healthier patients, who are in a great deal of chronic pain.

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  • Anonymous | 28-May-2012 2:41 pm

    Anonymous | 28-May-2012 2:33 pm

    I haven't had time to read the report but I disagree with this 'end of life' assumption having seen elderly patients considered to be dying, sometimes because a diagnostic test has been missed or poorly interpreted, leave the hospital on their own two legs some time later! they are hospitalised to treat disease and ease pain not to be pronounced almost dead and finished off! the last one I nursed had received last offices, family called in from a great distance to be with her, staff sitting with her for about four days on a rotation basis 24/24 and the last elderly nursing colleague shocked us all by feeding her beer - sips at first just to moisten her mouth as she was almost unconscious until she could sit up in bed and drink a full glass and looked very bright eyed and bushy tailed thanks to the care of this colleague. Diagnosis sequelae following multiple fractures and crush injuries including pelvis after RTA. Age over 80 years, moribund because lab results showing electrolyte imbalance had not been properly interpreted and her state was attributed to 'end of life' and high doses of morphine. A few days later, having previously rehabilitated from her fractures, she was waltzing down the corridor with a huge grin with her physio and discussing the date of discharge home with her doctor.

    We and the medical profession make far too many assumptions which we base our own judgements on which we do not have the right to do!

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