Palliative Care Prescribing: Pain

Key points

• NICE guidelines In 2012 NICE published guidelines on the use of opioids in palliative care. Selected points are listed below. Please see the link for more details. Starting treatment
• when starting treatment, offer patients with advanced and progressive disease regular oral modified-release (MR) or oral immediate-release morphine (depending on patient preference),
• if no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain. For example, 15mg modified-release morphine tablets twice a day with 5mg of oral morphine solution as required
• oral modified-release morphine should be used in preference to transdermal patches
• laxatives should be prescribed for all patients initiating strong opioids