Mid Essex Locality Guideline for Management of Adult Acute and Chronic Non-Cancer Pain in Primary care
|
|
- Lambert Hart
- 5 years ago
- Views:
Transcription
1 Guideline for Management of Adult Acute and Chronic Non-Cancer Pain in Primary care If possible patients should be assessed using a simple visual analogue scale VAS to determine the most appropriate stage of management on the pain ladder. This can also be used at review to gauge response to treatment- see appendix 1 Pain other than lower back pain Lower back pain STEP ONE Mild Pain (2-3 on VAS) Paracetamol 1g QDS Maximum 4g/24 hours +/- Non Steroidal Anti- Inflammatory Drug (NSAID) 1 Ibuprofen 400mg tds or Naproxen 500mg bd. Diclofenac should not be routinely used due to increased cardiac risk (appropriately risk assessed and concomitant PPI where indicated) +/- Non Steroidal Anti- Inflammatory Drug (NSAID) 1 Ibuprofen 400mg tds or Naproxen 500mg bd. Diclofenac should not be routinely used due to increased cardiac risk (appropriately risk assessed and concomitant PPI where indicated) Adjuvants such as Tricyclic antidepressants, and anticonvulsants may also be added at this stage) Paracetamol 1g QDS Maximum 4g/24 hours Patient: Young and/or Good renal function STEP TWO Moderate Pain (4-5 on VAS) Continue with STEP ONE plus Codeine phosphate 30 60mg QDS (Plus laxative as per formulary). This can be prescribed as co-codamol if taken with paracetamol If poor response or not tolerated; Tramadol HCl mg QDS Patient: Elderly Osteoarthritic Musculo-skeletal pain Acute back pain (not for routine initiation) Elderly Buprenorphine patch; Prescribed by brand Initiated at 5mcg/hour (Consideration should be given to the previous opioid history of the patient as well as to the current general condition and medical status of the patient-see equivalence charts below) and titrated as appropriate but not before 3 days when the maximum effect of a given dose is established. Oramorph oral solution; (morphine sulphate 10mg/5mL) 2.5mg 5mg every 4 hours PainManagementAdultsGUI201707v2.0final 1
2 STEP THREE Severe Pain (6-7 on VAS) Continue with STEP ONE plus Regular use of a potent opioid may be appropriate for certain cases of chronic non-malignant pain but should not be offered for the management of chronic low back pain; treatment should be supervised by a specialist and the patient should be assessed at regular intervals. N.B. Seek specialist advice before prescribing strong opioids for patients with CKD 3,4, and 5 First line; Oral Morphine sulphate; Prescribed by brand as per local policy. Either immediate or sustained release depending on patient preference. For breakthrough pain (this should be 1/6 th of total daily dose) during the titration phase consider oral immediate release doses of Morphine either as solution or tablets. PLUS Laxatives as per local formulary Anti-emetic- Domperidone 10mg TDS for short term use as required (up to maximum 7 days). If nausea persists optimise anti-emetic regimen before considering alternative analgesia. Second line (unresolved pain) Third line; Fourth line; Oxycodone 8; Prescribed by brand (e.g. Longtec (modified release) or Shortec (immediate release)). Second line opioid only use if morphine unsuitable or not tolerated. See equivalence charts below Tapentadol SR; Specialist initiation only Fentanyl patch Prescribed by brand; Only use if oral opioids are not suitable and analgesic requirements are stable. See dose equivalence chart below. Do not use for acute pain or opiate naïve patients. Record the anatomical position of currently applied patch to inform future decisions and actions Approximate Equivalent doses of Opioid (BNF online accessed 10/2/17) Analgesic Route Dose ORAL; Morphine Oral 10mg Codeine Oral 100mg Dihydrocodeine Oral 100mg Oxycodone Oral 6.6mg Tramadol Oral 100mg INJECTION; Morphine IM,IV,SC 5mg Diamorphine IM,IV,SC 3mg PainManagementAdultsGUI201707v2.0final 2
3 Approximate Equivalent doses of Patches to 24 hr doses of oral Morphine (BNF online accessed 10/2/17) Morphine Salt daily Buprenophine Patch Morphine Salt daily Fentanyl Patch 12mg BuTec 5 (7 day patch) 30mg Fentanyl 12 Patch 24mg BuTec 10 (7 day patch) 60mg Fentanyl 25 Patch 48mg BuTec 20 (7 day patch) 120mg Fentanyl 50 Patch 84mg Transtec 35 (4 day 180mg Fentanyl 75 Patch patch) 126mg Transtec 52.5 (4 day 240mg Fentanyl 100 patch) Patch 168mg Transtec 70 (4 day patch) Guideline for Pain Management in Adults To maintain freedom from pain, drugs should be given by the clock, that is every 3 6 hours, rather than on-demand. An exception is in renal failure (CKD levels 4-5) where opioids must be given on-demand in an immediate release form to avoid drug accumulation. Treatment should be initiated at the step most relevant to the presenting degree of pain. Medication will be stepped up or down accordingly in line with persistence or easing of pain and also in respect of signs of toxicity or severe side effects. Opioid medication should be reviewed as appropriate and the dose titrated accordingly. Initially, an immediate release preparation should be prescribed four hourly and when required. The total dose of opioid used within a 24 hour period can then be calculated and used to determine an appropriate regime using a 12 hourly (slow release) preparation, with a breakthrough dose 1/6 th of the total daily dose. NOTES: 1. Regarding NSAIDs at STEP ONE, gastrointestinal protection is required for patients at increased risk of GI bleeding. A Proton Pump Inhibitor, PPI (omeprazole or lansoprazole capsules), should be prescribed for the following patients: aged > 65 years; taking drugs known to increase bleeding risk such as steroids, anticoagulant therapy or antidepressants (SSRI and SNRI); requiring long-term NSAID; co-morbidity. NSAIDs should be avoided in asthmatic patients who are known to get worsening bronchospasm with NSAIDs. NSAIDs should be used with caution in the elderly and women who are experiencing fertility issues. They should also be avoided in pregnancy, particularly during the third trimester. 2. Codeine and stronger opioids cause constipation. A laxative should be prescribed and the patient advised to start taking it at the same time as the opioid. NB. Targinact (oxycodone/naloxone) has been reviewed by the Area Prescribing Committee but due to a lack of good evidence remains NON-FORMULARY and should not be prescribed. 3. At STEP TWO, Tramadol is to be prescribed with caution in the following patients: elderlyelimination may be prolonged [aged 75+ (consider 50mg tds)]; palliative care patients; renal failure (CKD levels 3 5); hepatic impairment; history of seizures/epilepsy (risk of convulsions may increase, contraindicated in uncontrolled epilepsy); pregnancy; on warfarin therapy; or PainManagementAdultsGUI201707v2.0final 3
4 serotonergic drugs (SSRI, SNRI, MAOI, Tricyclics and Mirtazapine may all cause serotonin toxicity). 4. BuTec patch dose adjustment: When starting, analgesic effect should not be evaluated until the patch has been worn for 72 hours (to allow for gradual increase in plasma-buprenorphine concentration) if necessary, dose should be adjusted at 3-day intervals using a patch of the next strength or two patches of the same strength (applied at same time to avoid confusion). Max. two patches can be used at any one time. Wait 24 hours before initiating a slow release opioid. 5. At STEP THREE: Caution is recommended in the use of strong opioids in opioid naïve patients. Before prescribing strong opioids, it is important to first establish if patients are opioid naïve to minimise risk of adverse events of administering strong opioids by titrating immediate release opioids up, starting with a low dose. 6. The prescribing of opioids will often be as sustained-release oral or patch formulation and there is potential for prescribing and dispensing errors involving confusion with names, formulations and dosage calculations when prescribed generically. These products should therefore be prescribed by brand. If Pharmacists receive scripts written generically the brand required should be confirmed and this information should be recorded on the patient s PMR. 7. Oxycodone; Prescribe by brand; This should ONLY be used where Morphine is not appropriate due to side effects (such as confusion, hallucinations, myoclonic jerks), excessive sickness despite adequate dosages of anti-emetics (including a trial of a buccal anti-emetic) or rash. PainManagementAdultsGUI201707v2.0final 4
5 Appendix I Mid Essex Locality Oxycodone Prescribing Information Patients should only be prescribed oxycodone where morphine is not appropriate for the following reasons: They develop side-effects with morphine such as confusion, hallucinations, myoclonic jerks; They have excessive sickness DESPITE taking anti-emetics (including a trial of the buccal anti-emetics); They develop an associated rash; Oxycodone should be prescribed by BRAND name. Prescribers must be aware of the high potential for confusion and errors due to the different release characteristics of these products and therefore to avoid confusion and allow continuity of supply, should prescribe oxycodone by brand name. Such practice should reduce the potential for dosing, dispensing and administration errors and reduce confusion for patients. There are significant risks of overdose when a fast acting product of short duration is used in error for the slow acting, longer duration products. Preparations Oral Injection Immediate release oxycodone Shortec capsules Shortec liquid Modified release (long acting) oxycodone Oxycontin tablets Longtec tablets Oxycodone injection Oxynorm injection 5mg, 10mg, 20mg 1mg/1ml, 10mg/ml 5mg, 10mg, 20mg, 40mg, 80mg 10mg/ml. 50mg/ml Dosage & Administration Immediate release oral oxycodone: Prescribe 4 hourly regularly and use the same dose as required for breakthrough pain. Modified release (long acting) oral oxycodone: o Prescribe 12 hourly, with 1/6 th of the 24 hour dose as immediate release oral oxycodone for breakthrough pain. o Biphasic action; a rapid release is followed by a controlled release phase. If the patient has pain when the dose of modified release (long acting) oxycodone is given, wait an hour before giving a breakthrough dose of immediate release oxycodone. Oxycodone injection: o Continuous subcutaneous infusion in a syringe driver or pump over 24 hours. o In addition, prescribe 1/6 th of the 24 hour infusion dose subcutaneously, 1-2 hourly as required for breakthrough pain. o If the infusion dose is greater than 60mg/24 hours, use another opioid for breakthrough injections; prescriptions should have clear guidance on the frequency that doses can be administered (low concentration of oxycodone preparation limits dose for sc injection to 10mg in 1ml). o Diluent: water for injection PainManagementAdultsGUI201707v2.0final 5
6 Laxatives: Regular opioids cause constipation. Prescribe a laxative as per local formulary at the same time as initiation of the opioid. DO NOT prescribe Targinact (oxycodone/naloxone) which is NON-FORMULARY Title Adult Acute and Chronic Pain Guidelines Document reference PainManagementAdultsGUI201707v2.0final Author Medicines Management Team MECCG Consulted with Dr Ahmed Mayet, Clinical Lead for Planned Care Mid Essex CCG Approved by Medicines Management Committee Date approved June 2017 Next review date June 2020 Previous version Key changes PainManagementAdultsGUI201011v01final Document management added Include lower back pain as a separate treatment plan for Step One Amendment of BuTrans reference to BuTec Updated to reflect NICE NG59:low back pain and sciatica in over 16s PainManagementAdultsGUI201707v2.0final 6
Berkshire West Area Prescribing Committee Guidance
Guideline Name Berkshire West Area Prescribing Committee Guidance Date of Issue: September 2015 Review Date: September 2017 Date taken to APC: 2 nd September 2015 Date Ratified by GP MOC: Guidelines for
More informationGuidelines for the Management of Chronic Non-Malignant Pain (CNMP) in Primary Care (not including neuropathic pain (NeP).
Surrey (East Surrey CCG, Guildford & Waverley CCG, North West Surrey CCG, Surrey Downs CCG & Surrey Heath CCG) North East Hampshire & Farnham CCG and Crawley, Horsham & Mid-Sussex CCG Guidelines for the
More informationGUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS
GUIDELINES ON THE MANAGEMENT OF PAIN DUE TO CANCER IN ADULTS Bristol Palliative Care Collaborative Contact Numbers: Hospital Specialist Palliative Care Teams: North Bristol 0117 4146392 UH Bristol 0117
More informationAnalgesia. This is widely used in palliative care. It has antipyretic and analgesic effects but no anti-
Page 1 of 8 Analgesia The World Health Organisation (WHO, 1990) has devised a model to assist health care professionals in the management of cancer pain. The recommendations include managing pain, by the
More informationAnalgesia in patients with impaired renal function Formulary Guidance
Analgesia in patients with impaired renal function Formulary Guidance Approved by Trust D&TC: January 2010 Revised March 2017 Contents Paragraph Page 1 Aim 4 2 Introduction 4 3 Assessment of renal function
More informationPalliative Prescribing - Pain
Palliative Prescribing - Pain LAURA BARNFIELD 21/2/17 Aims To understand the classes of painkillers available in palliative care To gain confidence in counselling regarding opiates To gain confidence prescribing
More informationBJF Acute Pain Team Formulary Group
Title Analgesia Guidelines for Acute Pain Management (Adults) in BGH Document Type Issue no Clinical guideline Clinical Governance Support Team Use Issue date April 2013 Review date April 2015 Distribution
More informationFor patients and their carers this means smoother symptom control, better support in a crisis, and avoidance of admission if that is their choice.
Bedfordshire Palliative Care Palliative Care Medicines Guidance This folder has been produced to support professionals providing palliative care in any setting. Its aim is to make best practice in palliative
More informationGUIDELINES AND AUDIT IMPLEMENTATION NETWORK
GUIDELINES AND AUDIT IMPLEMENTATION NETWORK General Palliative Care Guidelines The Management of Pain at the End Of Life November 2010 Aim To provide a user friendly, evidence based guide for the management
More informationDoncaster & Bassetlaw Cancer Locality. Palliative Care Core Formulary
Doncaster & Bassetlaw Cancer Locality Palliative Core Formulary Approved by Doncaster & Bassetlaw Hospitals NHS Foundation Trust Drugs and Therapeutics Committee. DJ14/2155 Oct 2014 Review date: Oct 2017
More informationOpioid rotation or switching may be considered if a patient obtains pain relief with one opioid and is suffering severe adverse effects.
Dose equivalence and switching between opioids Key Messages Switching from one opioid to another should only be recommended or supervised by a healthcare practitioner with adequate competence and sufficient
More informationClinical Guideline. Guidelines for the use of opioid analgesics in the management of acute pain in adults
Clinical Guideline Guidelines for the use of opioid analgesics in the management of acute pain in adults Document detail Document location West Kent and MTW Formulary Version 1.0 Effective from July 2017
More informationSupporting Last Days of Life Symptom Control Medication Guidance: Algorithm. Agitation & Anxiety
Agitation & Anxiety (Exclude or treat REVERSIBLE causes*) Patient is anxious / frightened, but lucid Patient is confused, agitated and / or hallucinating MIDAZOLAM 2.5-5mg s/c (Max total 24 hour dose of
More informationPrimary care review of Tramadol Prescribing
Primary care review of Tramadol Prescribing Aim of the Audit To ensure the prescribing of tramadol is safe, appropriate and regularly reviewed, in line with local chronic pain guidelines 1 Background Tramadol
More informationAdult Opioid Prescribing Guidelines for Acute or Persistent Pain
Adult Opioid Prescribing Guidelines for Acute or Persistent Pain Author: Sponsor/Executive: Responsible committee: Consultation & Approval: (Committee/Groups which signed off the policy, including date)
More informationSYMPTOM MANAGEMENT GUIDANCE FOR PATIENTS RECEIVING PALLIATIVE CARE AT ROYAL DERBY HOSPITAL
SYMPTOM MANAGEMENT GUIDANCE FOR PATIENTS RECEIVING PALLIATIVE CARE AT ROYAL DERBY HOSPITAL If a patient is believed to be approaching the end of their life, medication should be prescribed in anticipation
More informationEnd of life prescribing guidance
End of life prescribing guidance Introduction This guidance has been prepared to ASSIST IN DECISION MAKING for the prescribing and monitoring of medicines useful in the management of symptoms commonly
More informationQ&A: Opioid Prescribing for Chronic Non-Malignant Pain
NHS Hastings and Rother Clinical Commissioning Group Chair Dr David Warden Chief Officer Amanda Philpott NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group Chair Dr Martin Writer Chief Officer
More informationNHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery
Acute Sector NHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery Co-ordinators: Dr Karen Cranfield, Consultant Anaesthetist, Lead Acute Pain Sector
More informationPain management in palliative care. Dr. Stepanie Lippett and Sister Karen Davies-Linihan
Pain management in palliative care Dr. Stepanie Lippett and Sister Karen Davies-Linihan contents Concept of total pain Steps in pain management Recognising neuropathic pain WHO analgesic ladder Common
More informationPRESCRIBING GUIDELINES FOR SYMPTOM MANAGEMENT IN THE DYING PATIENT
PRESCRIBING GUIDELINES FOR SYMPTOM MANAGEMENT IN THE DYING PATIENT A collaboration between: St. Rocco s Hospice, Bridgewater Community Healthcare NHS Trust, NHS Warrington Clinical Commissioning Group,
More informationEnhanced Community Palliative Support Services. Lynne Ghasemi St Luke s Hospice
Enhanced Community Palliative Support Services Lynne Ghasemi St Luke s Hospice Learning Outcomes Define the different types of pain Describe the process of pain assessment Discuss pharmacological management
More informationGateshead Pain Guidelines for Chronic Conditions
Gateshead Pain Guidelines for Chronic Conditions Effective Date: 13.2.2013 Review Date: 13.2.2015 Gateshead Pain Guidelines: Contents PAIN GUIDELINES Chronic Non-Malignant Pain 5 Musculoskeletal Pain 6
More informationPALLIATIVE CARE PRESCRIBING GUIDELINES LANCASHIRE AND SOUTH CUMBRIA PALLIATIVE AND END OF LIFE CARE ADVISORY GROUP 2014
PALLIATIVE CARE PRESCRIBING GUIDELINES LANCASHIRE AND SOUTH CUMBRIA PALLIATIVE AND END OF LIFE CARE ADVISORY GROUP 2014 Are you reading the most up to date version? Review Date March 2016 NAVIGATIONAL
More information21 st June BDS BASHD Therapeutics Pain and Analgesia. BASHD Therapeutics Analgesics and Pain Management. Links to other BASHD content
Volume of Prescribing by Dentists 2011 ( a reminder) BASHD Therapeutics Analgesics and Pain Management Analgesics account for 1 in 80 dental prescriptions made A lot more analgesics will be suggested for
More informationBACKGROUND Measuring renal function :
A GUIDE TO USE OF COMMON PALLIATIVE CARE DRUGS IN RENAL IMPAIRMENT These guidelines bring together information and recommendations from the Palliative Care formulary (PCF5 ) BACKGROUND Measuring renal
More informationPALLIATIVE CARE PRESCRIBING
PALLIATIVE CARE PRESCRIBING LANCASHIRE AND SOUTH CUMBRIA SPECIALIST PALLIATIVE CARE SERVICES 2010 Refer to electronic verson site for latest information. Review Date September 2011 NAVIGATIONAL INSTRUCTIONS
More informationtablet/capsule Paracetamol 500mg
Formulary Item Restrictions and/or Advice Non-opioid analgesics + compound analgesic preparations Aspirin 75mg dispersible Aspirin 300mg dispersible Aspirin 300mg Aspirin 75mg EC Paracetamol 500mg / Paracetamol
More informationCoversheet for Network Site Specific Group Agreed Documentation
Coversheet for Network Site Specific Group Agreed Documentation This sheet is to accompany all documentation agreed by Pan Birmingham Cancer Network Site Specific Groups. This will assist the Network Governance
More informationPain Management Documents
Pain Management Documents Prescriber and Patient Resources Non-cancer Pain Guidance Neuropathic Pain Guidance Stopping or Switching low strength Buprenorphine Patches Red and Yellow Flags Medicines Management
More informationPALLIATIVE CARE PRESCRIBING
PALLIATIVE CARE PRESCRIBING LANCASHIRE AND SOUTH CUMBRIA SPECIALIST PALLIATIVE CARE SERVICES 2012 Refer to electronic verson at www.cancerlancashire.org.uk for latest information. Review Date January 2014
More informationNHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery in Adults. Consultation Group: See Page 5
NHS...... Grampian Acute Sector NHS Grampian Protocol For The Prescribing And Administration Of Oral Opioids Following Trauma Or Surgery in Adults Co-ordinators: Consultant Anaesthetist, Lead Acute Pain
More informationPAIN MANAGEMENT Patient established on oral morphine or opioid naive.
PAIN MANAGEMENT Patient established on oral morphine or opioid naive. Important; It is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member
More informationDrugs used for the treatment of pain Simple Analgesics Weak Opioids Strong Opioids Oral Strong Opioids Transdermal Strong Opioids Subcutaneous
Drugs used for the treatment of Simple Analgesics Weak Opioids Strong Opioids Oral Strong Opioids Transdermal Strong Opioids Subcutaneous Adjuvant analgesics Non Steroidal Anti-Inflammatory Drugs (NSAIDs)
More informationSwitching Tramacet to paracetamol alone or paracetamol and codeine
Bulletin 62 February 2014 Community Interest Company Switching Tramacet to paracetamol alone or paracetamol and codeine This is one of a number of bulletins providing further information on medicines contained
More informationGG&C Chronic Non Malignant Pain Opioid Prescribing Guideline
GG&C Chronic Non Malignant Pain Opioid Prescribing Guideline Background Persistent pain is common, affecting around five million people in the UK. For many sufferers, pain can be frustrating and disabling,
More informationNEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES
NEUROPATHIC CANCER PAIN STANDARDS AND GUIDELINES GENERAL PRINCIPLES Neuropathic pain may be relieved in the majority of patients by multimodal management A careful history and examination are essential.
More informationSYRINGE DRIVER MEDICATIONS
SYRINGE DRIVER MEDICATIONS Christine Hull & Anita Webb Staff Nurses, Hospice in the Home 2015 Analgesics:- Groups of Medication used in Syringe Drivers Morphine sulphate Diamorphine Oxycodone Alfentanil
More informationPrescribing and Administration of Analgesia within Maternity
Prescribing and Administration of Analgesia within Maternity CONTENTS Introduction and Who The Guideline Applies To... 2 UHL Paracetamol Prescribing Guideline... 2 Oral dosing... 2 Intravenous dosing...
More informationGeneral Palliative Care Guidelines for the Management of Pain at the End of Life in Adult Patients
General Palliative Care Guidelines for the Management of Pain at the End of Life in Adult Patients February 2011 Contents Introduction 3 Understanding Pain 5 Principles of Pain Management 8 Assessment
More informationSupportive Care. End of Life Phase
Supportive Care End of Life Phase Guidelines for Health Care Professionals In the care of patients with established renal failure who are in the last days of life References: Chambers E J (2004) End of
More informationRenal Palliative Care Last Days of Life
Renal Palliative Care Last Days of Life Introduction This guideline is an aid to clinical decision-making and good practice for patients with stage 4-5 chronic kidney disease (egfr
More informationCare of the Dying. For dosing in severe renal impairment see separate guidance for care of the dying in severe renal failure.
Care of the Dying Early diagnosis of the dying process allows for adequate preparation of the patient, the family and the carers. This clinical guidance covers the prescribing and management of patients
More informationGuidelines for the Pharmacological Management of Chronic Pain in Primary Care. December 2012
Guidelines for the Pharmacological Management of Chronic Pain in Primary Care December 2012 NHS Portsmouth CCG Fareham and Gosport CCG South Eastern Hampshire CCG 1 Guidelines for the Pharmacological Management
More informationOpioid Conversion Guidelines
Opioid Conversion Guidelines March 2015 Gippsland Region Palliative Care Consortium Clinical Practice Group Title Keywords Ratified Opioid, Conversion, Drug, Therapy, Palliative, Guideline, Palliative,
More informationGUIDELINES FOR PRESCRIBING AT THE END OF LIFE FOR PATIENTS WITH RENAL IMPAIRMENT (estimated glomerular filtration rate<30)
GUIDELINES FOR PRESCRIBING AT THE END OF LIFE FOR PATIENTS WITH RENAL IMPAIRMENT These guidelines have been produced in collaboration with Dr Lucy Smyth, Consultant in Renal Medicine, Royal Devon and Exeter
More informationRenal Prescribing at End of Life Guidance for Anticipatory prescribing for patients in renal failure (egfr<30) at the end of life
Guidance for Anticipatory prescribing for patients in renal failure (egfr
More informationANTICIPATORY PRESCRIBING FOR PATIENTS AT END OF LIFE WITH RENAL IMPAIRMENT
ANTICIPATORY PRESCRIBING FOR PATIENTS AT END OF LIFE WITH RENAL Doses of opiates must be proptional to current analgesic medication Please refer ALL patients on Methadone Ketamine to SPCT f advice. Patients
More informationYour A-Z of Pain Relief A guide to pain relief medicines. We care, we discover, we teach
Your A-Z of Pain Relief A guide to pain relief medicines We care, we discover, we teach Which pain medicines are you taking? Abstral (see Fentanyl Instant Tablets) Amitriptyline 5 Brufen (see Ibuprofen)
More informationPalliative care for heart failure patients. Susan Addie
Palliative care for heart failure patients Susan Addie Treatments The most common limiting and distressing complaint is of fatigue and breathlessness. Optimal treatment strategies relieve symptoms, improves
More informationMMG035 Symptom Management Guidelines for a Person thought to be in the Last Few Days and Hours of Life
MMG035 Symptom Management Guidelines for a Person thought to be in the Last Few Days and Hours of Life The following pages are guidelines for the management of common symptoms for a person thought to be
More informationOxycodone use still increasing
Oxycodone use still increasing 14 BPJ Issue 36 In BPJ 24 (Nov, 2009) we reported that oxycodone use in New Zealand had been steadily rising. Latest pharmaceutical dispensing data suggest that oxycodone
More informationCare in the Last Days of Life
Care in the Last Days of Life Introduction This guideline is an aid to clinical decision making and good practice in person-centred care for patients who are deteriorating and at risk of dying. The patient
More informationPain Management for Adult sickle cell disease patients: Information for patients, relatives and carers
Pain Management for Adult sickle cell disease patients: Information for patients, relatives and carers Why you should read this leaflet This leaflet will give you the information necessary to manage your
More informationPAIN MANAGEMENT Person established taking oral morphine or opioid naive.
PAIN MANAGEMENT Person established taking oral morphine or opioid naive. Important; it is the responsibility of the prescriber to ensure that guidelines are followed when prescribing opioids. Every member
More informationOpioid Type Pain Killers
Opioid Type Pain Killers Information for patients, relatives and carers For more information, please contact: Palliative Care Team 01904 725835 (York) 01723 342446 (Scarborough) Renal Department 01904
More informationSHARED CARE GUIDELINE For
SHARED CARE GUIDELINE For Ketamine in Palliative Care Implementation Date: 26.1.2011 Review Date: 26.1.2013 This guidance has been prepared and approved for use within Gateshead in consultation with Primary
More informationStrong Opioid Guidelines for the treatment of chronic non-malignant pain
Strong Opioid Guidelines for the treatment of chronic non-malignant pain Effective Date: December 2011 Reviewed: March 2014 Next review date: March 2016 This guideline has been prepared and approved for
More informationPAIN. TREATMENT TABLES Analgesics. NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose
NON-OPIOID SHORT-ACTING LONG-ACTING **** O PAIN TREATMENT TABLES Analgesics NON-OPIOID ANALGESICS Generic Name Trade Names (Examples) Duration Initial Dose Tramadol 50 mg Ultram Every 4 hours 1-2 tabs,
More informationPractical Management Of Osteoporosis
Practical Management Of Osteoporosis CONFERENCE 2012 Education Centre, Bournemouth.19 November The following companies have given funding towards the cost of this meeting but have no input into the agenda
More informationAnnex C. (variation to nationally authorised medicinal products)
Annex C (variation to nationally authorised medicinal products) Annex I Scientific conclusions and grounds for variation to the terms of the marketing authorisations Scientific conclusions Taking into
More informationAnalgesics: Management of Pain In the Elderly Handout Package
Analgesics: Management of Pain In the Elderly Handout Package Analgesics: Management of Pain in the Elderly Each patient or resident and their pain problem is unique. A complete assessment should be performed
More informationPRIMARY MANAGEMENT OF DRUG PRESCRIBING IN NON-MALIGNANT PAIN
NORTH OF TYNE GUIDELINES FOR: PRIMARY MANAGEMENT OF DRUG PRESCRIBING IN NON-MALIGNANT PAIN (EXCLUDING DETAILED RECOMMENDATIONS FOR LONG TERM STRONG OPIATES) February 2015 (minor update April 2017) 1 CONTENTS
More informationMedicines to treat pain in adults. Information for patients and carers
Medicines to treat pain in adults Information for patients and carers It is common to feel some pain after having an operation (surgery), trauma or an infection. Controlling pain is an important part of
More information5 MUSCULOSKELETAL SYSTEM
5 MUSCULOSKELETAL SYSTEM 5.01 NON-STEROIDAL ANTIILAMMATORY DRUGS (NSAIDS) *Acetylsalicylic Acid (Aspirin) Tab Soluble 300mg Diclofenac Sodium Tab 25mg, Supp 25mg, 50mg & 100mg (Voltaren) 300-900mg every
More informationChronic Non Malignant Pain Opioid Guideline
CLINICAL GUIDELINE Chronic Non Malignant Pain Opioid Guideline A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments. Clinical judgement should be exercised
More informationMorphine and other opioids for pain
Morphine and other opioids for pain INFORMATION FOR PATIENTS, CARERS AND FAMILIES Opioids are a group of medicines used to treat and manage moderate to severe pain. The most widely-known opioid is morphine.
More informationCare of the Dying Management in Severe Renal Failure
Care of the Dying Management in Severe Renal Failure Clinical Guideline Early recognition of the dying process allows for adequate preparation of the patient, the family and the carers. This clinical guidance
More informationOpioids in Palliative Care
Opioids in Palliative Care Brooke Building Palliative Care Team 0161 206 4609 All Rights Reserved 2017. Document for issue as handout. What are strong opioids? Strong opioids are painkillers which are
More informationSyringe driver in Palliative Care
Syringe driver in Palliative Care Introduction: Syringe drivers are portable, battery operated devices widely used in palliative care to deliver medication as a continuous subcutaneous infusion over 24
More informationPain. Christine Illingworth. Community Nurse St Luke s Hospice 17/5/17
Pain Christine Illingworth Community Nurse St Luke s Hospice 17/5/17 What is pain? Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage Pain is whatever
More informationCare of the Dying Management in Severe Renal Failure
Care of the Dying Management in Severe Renal Failure Clinical Guideline Early diagnosis of the dying process allows for adequate preparation of the patient, the family and the carers. This clinical guidance
More informationThe Mid Yorkshire Macmillan Specialist Palliative Care Team
The Mid Yorkshire Macmillan Specialist Palliative Care Team Morphine and Strong Opioid information leaflet Information for patients/carers The mere mention of Morphine can be enough to conjure up all sorts
More informationFighting the Good Fight: How to Convert Opioids Just Right!
Fighting the Good Fight: How to Convert Opioids Just Right! Tanya J. Uritsky, PharmD, BCPS, CPE Clinical Pharmacy Specialist - Pain Medication Stewardship Hospital of the University of Pennsylvania - Philadelphia,
More informationLong Term Care Formulary HCD - 08
1 of 5 PREAMBLE Opioids are an important component of the pharmaceutical armamentarium for management of chronic pain. The superiority of analgesic effect of one narcotic over another is not generally
More informationAnticipatory Medications for End of Life Patients. Doses must be proportional to the current analgesic medication YES NO YES NO
Anticipatory Medications for End of Life Patients oses must be proportional to the current analgesic medication Please refer ALL patients on Methadone or Ketamine to palliative care team for advice. Patients
More informationConservative Management of Uraemia
Conservative Management of Uraemia Information for Health Professionals Renal Department The York Hospital and Scarborough Hospital Tel: 01904 725370 For more information, please contact: The Renal Specialist
More informationPrescribing Examples: Basics
Prescribing Examples: Basics 7 0 Pregabolin 5 50mg 05.. 5 6 7 8 9 5 6 5 5 5 5 50 50 50 50 75 75 RF RF RF RF RF RF 5 5 5 5 50 50 50 PJ TF PJ PJ TF TF TF 50 75 75 75 75 TF A: REGULAR PRERIPTION SHEET 5 6
More informationB. Long-acting/Extended-release Opioids
4 Opioid tolerance is assumed in patients already taking fentanyl 25 mcg/hr OR daily doses of the following oral agents for 1 week: 60 mg oral morphine, 30 mg oxycodone, 8 mg hydromorphone, 25 mg of oxymorphone
More informationWest Midlands Palliative Care Physicians. Palliative care. Guidelines for the use of drugs in symptom control
West Midlands Palliative Care Physicians Palliative care Guidelines for the use of drugs in symptom control Revised Jan 2012 1 5th Edition, 2012 Guidelines for the use of drugs in symptom control These
More informationPAIN AND SYMPTOM MANAGEMENT GUIDANCE IN THE LAST DAYS OF LIFE
PAIN AND SYMPTOM MANAGEMENT GUIDANCE IN THE LAST DAYS OF LIFE Reference: DCM029 Version: 1.1 This version issued: 07/06/18 Result of last review: Minor changes Date approved by owner (if applicable): N/A
More informationTHE EAPC OPIOID GUIDELINES: PROCESS, RESULTS AND FUTURE DEVELOPMENT
1 THE EAPC OPIOID GUIDELINES: PROCESS, RESULTS AND FUTURE DEVELOPMENT Jaegtvolden 4-5 June 2012 14. 12. 2012 2 1 3 WHO ANALGESIC LADDER (1996) NSAID +/- Adjuvant STEP II OPIODS Opids for mild to moderate
More informationUnderstanding your take home medications from the surgical ward. Information for Patients
Understanding your take home medications from the surgical ward Information for Patients i Information for Patients Please read this leaflet before taking the medications that have been prescribed for
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: HIM.PA.139 Effective Date: 12.01.17 Last Review Date: 02.18 Line of Business: Health Insurance Marketplace Revision Log See Important Reminder at the end of this policy
More informationPain management in Paediatric Palliative Care. Dr Jane Nakawesi 14 th August 2017
Pain management in Paediatric Palliative Care Dr Jane Nakawesi 14 th August 2017 Content Management of pain in children Non pharmacological Pharmacological Exit level outcomes The participants will: Know
More informationPolicy on Pharmacological Therapies Practice Guidance Note Reducing Dosing Errors with Opioid Medicines V04
Policy on Pharmacological Therapies Practice Guidance Note Reducing Dosing Errors with Opioid Medicines V04 Date issued Issue 1 Nov 2018 Planned review Nov 2021 PPT-PGN 18 part of NTW(C)38 Pharmaceutical
More informationAETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization
AETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization Policy applies to all formulary and non-formulary schedules II V opioid narcotics, including tramadol and codeine, as
More informationAppendix D: Drug Tables
Appendix D: Drug Tables A. Short-acting, Orally Administered Opioids Table D-1: Use of Short-acting, Orally Administered Opioids in Adults [198] Additional Maximum APAP dose: 4000 mg/d (2000 mg/d in chronic
More informationPAEDIATRIC DOSAGE GUIDELINES For management of post-operative acute pain
Index No: MMG43 PAEDIATRIC DOSAGE GUIDELINES For management of post-operative acute pain Version: 3.1 (Includes anti-emetics and naloxone) Date ratified: July 2013 Ratified by: (Name of Committee) Name
More informationAlgorithms for Symptom Management. In End of Life Care
Algorithms for Symptom Management In End of Life Care The Use of Drugs Beyond Licence (off label) -The Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK regulates the activity of the
More informationSymptom Control in the Community Setting. Dr Andrew Tysoe-Calnon
Symptom Control in the Community Setting Dr Andrew Tysoe-Calnon Lead Consultant t Common symptoms Pain Agitation Shortness of breath Nausea and vomiting Intestinal obstruction Confusion Pain Occurs in
More informationDocument Details. Ibuprofen 200mg tablets and Ibuprofen oral liquid 100mg in 5ml
Title Document Details Patient Group Direction (PGD) Ibuprofen 200mg tablets and Ibuprofen oral liquid 100mg in 5ml Trust Ref No 1445-36348 Local Ref (optional) Main points the document The treatment of
More informationDiamorphine 4 hour. alfentanil (500microgram/mL) Calculated by dividing 24 hour oral morphine dose by 30
If more information is required please seek help from specialist palliative care pioid dose conversion chart, syringe driver doses, rescue/prn doses and opioid patches Use the conversion chart to work
More informationTreating the symptoms of kidney failure
Treating the symptoms of kidney failure Information for patients, relatives and carers Renal Department The York Hospital and Scarborough Hospital Tel: 01904 725370 For more information, please contact:
More informationPatient Information Leaflet. Opioid leaflet. Produced By: Chronic Pain Service
Patient Information Leaflet Opioid leaflet Produced By: Chronic Pain Service November 2012 Review due November 2015 1 Your Pain Specialist has recommended treatment with strong pain killers (opioids).
More informationPersistent Pain Resources. Educational Slide Set
Persistent Pain Resources Educational Slide Set October 216 This document has been prepared by a multiprofessional collaborative group, with support from the All Wales Prescribing Advisory Group (AWPAG)
More informationLong-Acting Opioid Analgesics
Market DC Long-Acting Opioid Analgesics Override(s) Prior Authorization Step Therapy Quantity Limit Approval Duration Initial request: 3 months Maintenance Therapy: Additional prior authorization required
More informationNeuropathic Pain Treatment Guidelines
Neuropathic Pain Treatment Guidelines Background Pain is an unpleasant sensory and emotional experience that can have a significant impact on a person s quality of life, general health, psychological health,
More informationLong-Acting Opioid Analgesics
Market DC Long-Acting Opioid Analgesics Override(s) Prior Authorization Step Therapy Quantity Limit Approval Duration Initial request: 3 months Maintenance Therapy: Additional prior authorization required
More informationGuidelines on Choice and Selection of Antidepressants for the Management of Depression
Guidelines on Choice and Selection of Antidepressants for the Management of Depression 1. Introduction This guidance should be considered as part of a stepped care approach in the management of depressive
More information