Prescribing strong opioids for pain in adult palliative care: summary of NICE guidance

Pain is common in advanced cancer but also in the late stages of other incurable non-malignant diseases, such as heart failure and neurological conditions.1 2 Almost half of patients with advanced cancer are undertreated for their pain, largely because clinicians are reluctant to use strong opioids for effective analgesia.3 4 Strong opioids such as morphine are indicated for moderate to severe pain and should be prescribed only after a full assessment of the analgesic needs of the patient.

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care of people with advanced and progressive disease who require strong opioids for pain control.5 These patients are defined as those in moderate to severe pain who may never have used strong opioids, or those whose pain has been inadequately controlled by weak opioids such as codeine or tramadol. The guideline does not cover all aspects of pain management (including second line approaches) or pain control during the last days of life (for example, for patients who are being managed by the Liverpool care pathway, a care pathway that integrates the best aspects of care for dying patients that can be used in any clinical setting).