General Notes

Guidelines on Management of Chronic Non-Malignant Pain

NHS Lanarkshire Chronic Non-Malignant Pain Opioid Guideline

The Commission on Human Medicines (CHM) has recommended that fentanyl transdermal patches are contraindicated in opioid-naive patients in the UK. Other analgesics and other opioids should be used before prescribing fentanyl patches for non-cancer pain. Please see the MHRA Drug Safety Update (September 2020) for further information.

Guidelines on Management of Neuropathic Pain

NHS Lanarkshire Neuropathic Pain Guideline

Guidelines on Management of Migraine

SIGN 155: Pharmacological Management of Migraine – Full Guideline

SIGN 155: Pharmacological Management of Migraine – Quick Reference

Guidelines on Management of Cluster Headaches

NICE Clinical Guideline Headaches in over 12s: Diagnosis and Management [CG 150]

Palliative Care Guidelines

Scottish Palliative Care Guidelines

The morphine equivalences detailed throughout the formulary are taken from the BNF online. However, there are various resources available for calculating opioid conversion and ratios may vary depending on the resource used.

This link to an opioid conversion calculator may be particularly useful when rationalising treatment in patients taking multiple opioids.

When switching between opioids the equivalent dose of the new opioid should be reduced by 25% to allow for potential increased sensitivity to different opioids. A reduction of 50% could be considered in patients who are frail, elderly, on high doses of opioids or experience intolerable adverse effects.

A variety of patient information leaflets have been developed by the NHS Lanarkshire Prescribing Management Team to help support patient understanding of medicines that may be used to manage pain. These leaflets are available via the links below. Other NHS Lanarkshire patient information leaflets for Chronic Pain can be found here. 

Living Well with Chronic Pain

Getting the Best out of your Medicines: Opioids For People Living With Chronic Pain

Getting the Best out of your Medicines: Gabapentinoids For People Living With Chronic Pain