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The National Institute for Health and Clinical Excellence (NICE) issued guideline CG140 in May 2012, for professionals commencing strong opioids in adult palliative care patients.1 Although this guideline is for non-specialist professionals who initiate opioid treatment (eg, general practitioners and generalist hospital doctors), the implications for those working in specialist palliative care settings will be significant. It is important that NICE guidelines should facilitate and consolidate the ongoing dialogue between generalists and specialists in palliative care. Here, we summarise the recommendations to highlight areas that are of particular importance to specialist palliative care providers.
Development of this guideline followed the NICE process for short clinical guideline development.2 Recommendations within the guideline were made after systematic reviews had been conducted to consider the best available evidence. Where minimal evidence was available, the Guideline Development Group's experience and opinion of what constitutes good practice was debated, considered and summarised. The guideline takes effect at the point in time when a palliative care patient has moderate to severe pain, which necessitates commencing strong opioid analgesia. The guideline does not cover the last days of life, nor does it go further into recommendations for second-line approaches for pain control.
A number of key areas are addressed: communication, starting strong opioids (first-line treatment options, titrating the dose, maintenance phase and what to do when oral opioids are not suitable), management of breakthrough pain, and management of side effects (constipation, nausea and drowsiness). These are summarised in table 1.
The Guideline Development Group (GDG) highlighted that communication with patients starting opioids is often inadequate and should incorporate the …
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