OG2010 Opioid guidelines for long term pain including neuropathic pain (based on British Pain Society guidance January 2010) Initial management Paracetamol + Codeine or Dihydrocodeine (weak opioid) If stronger opioid required useTramadol before morphine + (if suitable) NSAID (consider GI protection + CVS assessment) If above medication taken beyond recommended dose or not controlling pain then consider opioids using guidelines + opioid use practitioner assessment tool (OUPA2010) Option 1 or Developed by NHS Kirklees + NHS Bradford+Airedale Medicines Management with Pain Services: Calderdale + Huddersfield NHS Foundation Trust + Bradford Teaching Hospitals NHS Foundation Trust + Mid-Yorkshire Hospitals NHS Trust November 2010 Review date November 2013 Version 1.0 Assess in 1 week Strong opioid started: (Option 1 or Option 2) use laxative to prevent constipation + antiemetic (e.g. Oramorph oral solution 10mg/5ml. 5mg every four Zomorph capsules 10mg – 20 mg b.d. Follow up assessment (Use OUPA2010 tool) Pain score VAS Follow up assessment (Use OUPA2010 tool) increase doses in increments Assess in 2 Assess in 2 Follow up assessment (Use OUPA2010 tool) increase dose as needed in increments of not more than half the previous prescribed dose Switch to equivalent M/R b.d Assess every 2 Cost comparison charts British Pain Society Opioid guidelines for clinicians Opioid dose equivalence ETOU2010 RESOURCES