Pain in advanced disease under-treated

  • Date: 30 May 2012

PAINĀ caused by advanced disease remains under-treated despite a range of opioids being recommended for use in the NHS, according to clinical guidelines produced recently by NICE.

The new guidelines are intended to ensure safe and consistent prescribing of opioids as a first-line treatment option for patients receiving palliative care for chronic or incurable illnesses.

Each year, around 300,000 people are diagnosed with cancer in the UK and it is thought another 900,000 people have heart failure. Others live with chronic illnesses such as kidney or respiratory conditions, or neurodegenerative conditions like motor neurone disease. For many of these people, strong opioids will be the only adequate source of pain relief. However, evidence suggests that pain caused by advanced disease remains under-treated with many patients worrying about the long-term use of opioids and the possibility of becoming addicted.

The new guidelines offer recommendations on patient communication including discussing concerns such as addiction, tolerance, side effects and fears that treatment implies the final stages of life. It also provides guidance on starting treatment and first-line maintenance therapy.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: "Many people with chronic or advanced conditions will experience a high level of pain which can only be treated by opioids such as morphine as weaker forms of pain relief will no longer be effective. However, we understand that patients can be anxious about using these medicines for a number of reasons. Likewise, healthcare professionals may not always be sure about when to prescribe certain types of opioids.

"The new guideline aims to address all those fears and provide clear advice to the NHS to ensure a consistent approach to treatment and ultimately help to drive up standards of care."


Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults

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