Opioids in palliative care: is the new NICE guideline relevant to specialist palliative care providers?
- 1Department of Palliative Medicine, Marie Curie Hospice Penarth, Penarth, UK
- 2University Hospital Llandough, Penarth, UK
- 3Velindre Hospital NHS Trust, Cardiff, UK
- 4Department of Palliative Medicine, Royal Marsden NHS Foundation Trust, London, UK
- 5NHLI, Imperial College, London, UK
- 6National Collaborating Centre for Cancer, Cardiff CF10 3AF, UK
- 7Leeds Institute of Life Sciences, Leeds University, Leeds, UK
- Correspondence to Dr Mark Taubert, Department of Palliative Medicine, Marie Curie Hospice Penarth, Bridgeman Road, Penarth, Cardiff CF64 3YR, UK;
Contributors All authors contributed to the conception and drafting of this article and revising it critically. They have all approved this version. MB and MT are guarantors.
The National Institute for Health and Clinical Excellence (NICE) issued guideline 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 guideline 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 salient …