PAD Formulary : Surrey Heartlands
PAD - Prescribing Advisory Database
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PAD Profile : Pain

Keywords :
PNMP, Ibuprofen, Naproxen, Tramadol, Buprenorphine, Morphine, Oramorph, Paracetamol, NSAIDs, Opioids, analgesia, analgesics, codeine phosphate, dihydrocodeine, co-codamol, co-dydramol, fentanyl, postherpetic neuralgia , PHN, post herpetic neuralgia, neuropathic pain, nerve pain, tricyclics, tricyclic antidepressants, TCA, amitriptyline, imipramine, nortriptyline, gabapentin, pregabalin, neurontin, lyrica, duloxetine, cymbalta, Diabetes, diabetic neuropathy, opioid patches
Brand Names Include :
Zydol,Marol,Butrans, Sevredol,MST, MXL, Oxynorm, Oxycontin, Oxycodone, cymbalta

Traffic Light Status

Status 1 of 1.

Status :
Trust Alignment :
Primary Care
ASPH
RSFT
SASH
SABP
Links :
BNF NICE SPC
Comments :
No comments returned.
Documents :

Guidelines

The following guidelines are available for this indication.

Other Drugs

Other Indications

Additional Documents

Type
Document
Review Date
Guidelines (Local)
Neuropathic Pain Guidelines for Primary Care - Oct 20
01 October 2023
Guidelines (Local)
Pharmacological management of persistent non-malignant pain in adults -updated December 2020
01 June 2021
Safety Information
NSAIDs - Safer Prescribing Aide Memoir - Jul 2019
01 July 2022
Safety Information
Opioid Patch Safety: Counselling Checklist
01 February 2024
Safety Information
Pregabalin Safety Messages - GP Version - SABP Aug 2020 (updated Mar 2021)
01 August 2023
Patient resource
Gabapentinoid Reduction - Patient_Information_Leaflet - Dec 2020
01 December 2023
Patient resource
Opioid Patch Information To Keep Patients Safe
01 February 2024
Patient resource
Pain (Persistent) - Opioids -Patient Information - April 2018.docx
Patient resource
Pain management - Prescription agreement (Patient) - June 2018.docx
Webpage
NICE NG215 - Medicines associated with dependence or withdrawal
Webpage
Opioid dose equivalents and changing opioids - Faculty of Pain Medicine
Webpage
Paracetamol - Prescribing weight-adjusted oral paracetamol in adults - British Hepatology Group - Mar 22
05 March 2025
Information
Pain -Opioids - Assessment Tool- April 2018.docx

Committee Recommendations

Date
Committee Name
Narrative
09 August 2023
Surrey Heartlands Medicines Safety Committee (MSC)

The Centre for Perioperative Care position statement on Modified Release Opioids - was agreed for use within Surrey Heartlands to support the safe use of opioids after surgery. See link 

https://cpoc.org.uk/sites/cpoc/files/documents/2023-05/CPOC%20MR%20Opioid%20statement.pdf

08 June 2022
Surrey Heartlands Medicines Safety Committee (MSC)

Prescribing weight-adjusted oral paracetamol in adults - British Hepatology Pharmacy Group Position Statement - was agreed for use within Surrey Heartlands to support the safe use of paracetamol. See link below.

09 February 2022
Surrey Heartlands Medicines Safety Committee (MSC)

The ‘OPIOID PATCH INFORMATION TO KEEP PATIENTS SAFE' leaflet for patients and 'OPIOID PATCH SAFETY: COUNSELLING CHECKLIST’ for healthcare professionals were agreed for use within Surrey Heartlands to support the safe use of opioid patches. See documents below.

02 December 2020
Surrey Heartlands Integrated Care System Area Prescribing Committee (APC)

The local guidelines for persistant non-malignant pain have been updated . A link to the opioid dose conversion from the Faculty of Pain Medicine has been included (Appendix 5) and a link is also provided below for reference- see guidelines and other pain resources below

04 December 2019
Surrey & North West Sussex Area Prescribing Committee (formerly Prescribing Clinical Network)

The Surrey & Sussex Area Prescribing Committee have made recommendations in relation to paracetamol dosing in frail elderly patients. 

There have been some case reports of liver failure associated with therapeutic doses of paracetamol in some patients. Frail elderly patients with a body-weight < 50kg and those with risk factors for hepatotoxicity such as cardiac, pulmonary and renal insufficiency in conjunction with old age, co-administration of medicines that induce liver enzymes, hepatitis and chronic alcohol consumption.  
 
The BNF recommends that clinical judgement should be used to adjust the dose of oral paracetamol in such patients. The clinicians may choose to either reduce the dosage or the frequency of administration of paracetamol. Co-administration of enzyme-inducing medications may also increase toxicity; paracetamol doses should be reviewed and reduced.

NOTE: Patients having IV paracetamol will already have had adjustments made based on body weight so no further adjustment should be required.

Associated BNF Codes

04. Central Nervous System
04.07.01. Non-opioid analgesics and compound preparations
04.07.02. Opioid analgesics
04.07.03. Neuropathic pain
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