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.