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Reassure patients about opioid effects

NICE says listening to concerns about opioids could improve concordance

Louise Prime

Friday, 02 December 2011

NICE is urging doctors to communicate clearly with patients in severe pain about the use and benefits of opioids, in its latest draft guidance published today. It said that if clinicians listen to and address patients’ common concerns and misconceptions about opioid painkillers, they are more likely to take them as prescribed and thereby benefit from better pain relief.

NICE said many patients with cancer or other conditions causing high levels of pain, such as kidney, respiratory or liver disease, feel reluctant to take opioid painkillers because they are very concerned about addiction or side-effects; or they may worry that doctors are focusing on pain relief at the expense of treating their underlying disease.

The draft guidance advises:

  • Ask patients to whom you are offering treatment with strong opioids, about their concerns – such as addiction, tolerance, side effects, or fears that treatment implies the final stages of life.
  • Offer patients access to frequent review of pain control and side-effects, as well as information on whom to contact out of hours, particularly during initiation of treatment.
  • When first starting treatment with strong opioids, offer patients with advanced and progressive disease regular oral sustained-release or immediate-release preparations (depending on patient preference and clinical presentation), with rescue doses of oral immediate-release preparations for breakthrough pain.
  • As first-line maintenance therapy, offer oral sustained-release morphine to patients with advanced and progressive disease who require strong opioids. Review and seek specialist advice if pain remains uncontrolled.
  • Advise patients that the nausea, mild drowsiness or impaired concentration that may occur when starting opioid therapy, or at dose increase, are likely to be transient.

Director of NICE’s centre for clinical practice, Dr Fergus Macbeth, said: “We know that many people worry about becoming addicted to this strong medication and have concerns about side effects. They also worry about focusing on pain relief rather than treating the underlying disease.

“The new draft guideline puts a strong emphasis on good communication between patient and healthcare professionals. This is key to ensuring that any doubts or uncertainties are addressed, thereby enabling the patient to feel content in following what has been prescribed and therefore potentially improving their pain control and reducing any associated side effects.”

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