Patients using opioids to relieve pain when receiving palliative care for chronic or incurable illnesses will be given advice on their use as part of a new clinical guideline published by NICE.

The guideline aims to ensure safe and consistent prescribing of opioids as a first line treatment option through clear communication and instructions on their initial and on-going use.

Dr Damien Longson, Chair of the Guideline Development Group for the guideline, said the new measures are “key to ensuring any worries or uncertainties are addressed”.

Evidence found, NICE said, that pain caused by advanced disease remains under-treated, despite a range of opioid options available for use on the NHS.

Patients are also wary, research suggests, about the long-term use of the treatments, their side-effects and the possibility of becoming addicted.

As part of the guideline, clinicians will discuss any worries with patients when prescribing strong opioids and offer access to a frequent review of pain control and side-effects.

When starting treatment, patients should be offered advanced and progressive disease regular oral sustained-release or immediate-release preparations.

Also, oral sustained-release morphine should be offered as a first-line maintenance therapy to patients with advanced and progressive disease who require strong opioids.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said there were currently a number of uncertainties around the use of the drugs which the guideline hopes to erase.

“Many people with chronic or advanced conditions will experience a high level of pain which can only be treated by opioids such as morphine as weaker forms of pain relief will no longer be effective,” he said.

“However, we understand that patients can be anxious about using these medicines for a number of reasons. Likewise, healthcare professionals may not always be sure about when to prescribe certain types of opioids.”

A new service to coordinate 24-hour palliative care in Bedfordshire has been commended for improving patients’ experience during the difficult phase of end of life care.

The Bedfordshire Partnership for Excellence in Palliative Support (PEPS) Coordination Centre is an innovative venture between NHS Bedfordshire, local health and care services and the national charity Sue Ryder.

It is the first point of contact for patients, families, carers and healthcare professionals who require 24-hour advice and support for palliative care.

The service is being piloted across the country and has also attracted national interest. The Centre will host a visit from DH leaders working on an end of life care strategy later this month.

Launched in December last year, more than 360 local people have already registered to use the service.

Sarah Martin-Merchant, Care Centre Manager at Sue Ryder-St John’s Hospice, said that the majority of people like to remain at home during their palliative care.

“The PEPS Service brings organisations together to deliver this care, including that needed out-of-hours, which is in line with patients’ preferences and choices,” she said. 

“By working as a partnership, PEPS aims to minimise the need for hospital admission by providing more end of life care at home and to improve continuity of care for patients, their families and carers.”