Reason for the decision

We found 35 new studies through surveillance of this guideline.

This included new evidence that supports current recommendations, including:

• communication with patients and their carers
• titrating the starting dose of strong opioids
• first-line maintenance treatment
• first-line treatment if oral opioids are not suitable (transdermal patches)
• first-line treatment for breakthrough pain in patients who can take oral opioids
• management of constipation.

We did not find any new evidence on subcutaneous delivery as first-line treatment if oral opioids are not suitable, management of nausea, or management of drowsiness.

None of the new evidence considered in surveillance of this guideline was thought to have an effect on current recommendations.

In addition, no major ongoing studies or research due to be published in the next 3–5 years was identified.

How we made the decision

We check our guidelines regularly to ensure they remain up to date. We based the decision on surveillance 4 years after the publication of Palliative care for adults: strong opioids for pain relief (2012) NICE guideline CG140.

For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in ‘Developing NICE guidelines: the manual’.

Previous surveillance update decisions for the guideline are on our website.

New evidence

We found 30 new studies in a search for randomised controlled trials and systematic reviews published between 27 November 2013 and 22 February 2016. We also considered 1 additional study identified by members of the guideline committee who originally worked on this guideline.

Evidence from 4 studies identified in an Evidence Update published 2 years after publication of the guideline was also considered.

From all sources, 35 studies were considered to be relevant to the guideline.

We also checked for relevant ongoing research, which will be evaluated again at the next surveillance review of the guideline.

See appendix A: summary of new evidence from surveillance and references for all new evidence considered.

Views of topic experts

We considered the views of topic experts, including those who helped to develop the guideline.

Views of stakeholders

Stakeholders commented on the decision not to update the guideline and place NICE guideline CG140 on the static list. Overall, six stakeholders commented. See appendix B for stakeholders’ comments and our responses.

Five stakeholders commented on the proposal to not update the guideline: 1 agreed with the decision; 2 disagreed with the decision; and 2 noted that they had no comments on the proposals. Six stakeholders commented on the proposal to put the guideline on the static list: 2 agreed with the decision; 2 disagreed with the decision; and 2 noted that they had no comments on the proposals.

One stakeholder suggested changes to several review questions addressing the side-effects of opioids. However, surveillance includes all new evidence relevant to the scope and no evidence to address either the original or the suggested questions was identified. No new ongoing or published studies were identified by the stakeholders to support views that the guideline should be updated or that it should not be placed on the static list. Finally, extensions to the scope were suggested, but these were considered to be covered by NHS England’s specialised pain commissioning service.

Overall, we decided not to update the guideline and place NICE guideline CG140 on the static list.

See ensuring that published guidelines are current and accurate in ‘Developing NICE guidelines: the manual’ for more details on our consultation processes.

NICE Surveillance programme project team

• Sarah Willett
  Associate Director
• Philip Alderson
  Consultant Clinical Adviser
• Emma McFarlane
  Technical Adviser
• Lynne Kincaid
  Technical Analyst

The NICE project team would like to thank the topic experts who participated in the surveillance process.