Date Published: 23 May 2012

Patients to benefit from better advice on pain control

New guidance for doctors and other prescribers on the use of strong painkillers for patients with chronic or incurable disease has been welcomed by researchers at the University of Leeds.

The (UK) National Institute for Health and Clinical Excellence (NICE) is launching a new clinical guideline on the safe use of opioids - a family of drugs derived from the opium poppy that have been identified by the World Health Organization (WHO) as essential in the treatment of severe pain. The new guideline should help ensure that when patients receiving palliative care for chronic or incurable illnesses start treatment with strong opiods, the drugs are prescribed safely and consistently.

Professor Mike Bennett, St Gemma's Professor of Palliative Medicine at Leeds University (Yorkshire, England), was a member of the expert group that helped develop the new guidance. Commenting on the document he said:

" Until now, there has been little guidance regarding the safe prescribing of opioids, especially when the treatment is started by non-specialists such as GPs or hospital doctors not familiar with these types of medicines or patients. Despite increased availability of these medicines, pain from advanced conditions remains under-treated. This can be due to a variety of reasons such as fears over side-effects or confusion over which opioid treatment would work best. This guideline gives clear recommendations and should instigate a real clinical change in the way opioids are prescribed."

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 such as motor neurone disease. For many of these people, strong opioids will be the only adequate source of pain relief if other approaches have failed. However, evidence suggests that pain caused by advanced disease remains under-treated in the UK, despite a range of opioids being recommended for use in the National Health Service. Many patients also worry about the long-term use of opioids, their side-effects and the possibility of becoming addicted.

The guideline makes recommendations in a number of key areas. These include asking patients about their concerns regarding addiction or side effects before starting treatment; providing information on out-of-hours support, particularly at the start of treatment; offering medicines that give sustained pain relief over a long time period; and offering oral medicines that give immediate pain relief to control 'breakthrough' pain.

Leeds University researchers, led by Professor Bennett, are planning a programme of research into the management of cancer pain that will look at simple, practical steps that could help patients better control their pain. The work, which will be carried out in collaboration with St Gemma's Hospice in Leeds, will involve patients who are receiving palliative care and their carers.

" The biggest barrier to good pain control for patients with advanced cancer is not the lack of good drugs, but inadequate support and advice, poor communication, lack of pain monitoring, and a lack of access to painkillers. By working with patients and their carers to tackle each of these issues, we hope to minimise patients' distress from pain and reduce the number of avoidable hospital admissions," Professor Bennett said.

For more about pain see also our pages about ... neck pain, shoulder pain and elbow pain.

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