NICE releases new guidelines
for pain relief
If you have problems getting
your aches and pains
acknowledged – NICE agrees
you have a point
NICE (National Institure for Health and Clinical Excellence) has admited
Many of us who suffer are “under-treated for their pain”.
Sometimes morphine and other strong opoids are the only adequate pain relief source for many patients. So NICE wants doctors in England and Wales to make more use of these.
The guidelines recommend doctors discuss patients’ concerns: these may include addiction, tolerance, side-effects and fears that treatment implies the final stage of life.
The guidance deals with five opioids:
- diamorphine (heroin)
They come either from the opium poppy or are synthetically produced versions.
NICE says “misinterpretations and misunderstanding” have surrounded the use of strong opioids for decades, which has resulted in errors “causing under-dosing and avoidable pain, or overdosing and distressing adverse effects”.
There is also the legacy of Dr Harold Shipman. He used diamorphine to murder his victims, so it has doctors wary of prescribing strong opioids, and patients and their carers taking them.
What you can do
So cancer patients, who are worried that they are not being given adequate pain relief, can take note of Mike Bennett, St Gemma’s professor of palliative medicine at the University of Leeds He says “Almost half of patients with advanced cancer are under-treated for their pain, largely because clinicians are reluctant to use strong opioids.”
Prof Bennett said the issue also applied to the late stages of other conditions such as heart failure and neurological disorders.
In the British Medical Journal he says doctors should address patients’ concerns and reassure them that addiction is “very rare”.
Doctors are also told to advise patients about side-effects, including constipation, which can be treated with laxatives.
Will I become an addict?
Dr Damien Longson, Chair of the NICE Guideline Development Group said: “People worry they can become addicted, particularly if opioids are prescribed over an extended period of time. This guideline puts a strong emphasis on good communication between healthcare professionals and patients, which is key to ensuring any worries or uncertainties are addressed with timely and accurate information.”
Another person who welcomed the NICE guidelines, Dr Fiona Hicks, chairwoman of the Royal College of Physicians’ recent working party on improving end-of-life care, said she welcomed the new NICE guidelines with its “emphasis on strong communication with patients, including how to help patients cope with both taking opioids and deal with the side-effects.”
Supporting this comment, Sarah Wootton, chief executive of Compassion in Dying, said: “This guideline will support healthcare professionals in providing good end-of-life care across all settings, and will help to ensure that many people have what they consider to be a good death with their pain properly managed.”
What can I do?
Get your GP to refer you to the best pain management clinic at a hospital in your area.
Warning! a good clinic will have a long waiting list – but in this instance it could be a guarantee that others think the same as you, and want to make use of its expertise.
The Royal Marsden has an excellent Pain Management Clinic. It can take six months for a referral, but once there, patients say they have a long, long interview with one or sometimes two doctors. They are asked numerous questions, but the advice given is reassuring. Sarah B says “I found the assessment was extremely thorough. I was asked seaching questions. Asked to qualify some answers which proved they were actually listening to what I said, and at the end was given several options which are working out extremely well”. Afterwards I received an excellent summary of what was discussed, and am looking forward to my follow-up appointment to find out more.
So don’t ‘grin and bear it’. Official advice is you CAN take pain killers – with care.