What are the guidelines for prescribing opioids for acute pain management in primary care?

In primary care, opioids should be prescribed for acute pain management only when pain is moderate to severe and other analgesics such as paracetamol and NSAIDs are insufficient or contraindicated. Oral opioids are preferred, starting with the lowest effective dose and for the shortest duration necessary to control pain. Immediate-release formulations are recommended initially to allow dose titration and assessment of efficacy and side effects. Regular review of pain control and side effects is essential, with dose adjustments made to balance pain relief and adverse effects. Strong opioids should be used cautiously, with clear patient information about risks including addiction, tolerance, and side effects. Laxatives should be prescribed concurrently to prevent opioid-induced constipation. Specialist advice should be sought if pain is not controlled or if the patient has renal or hepatic impairment. Fast-acting fentanyl is not recommended as first-line rescue medication. Non-oral routes such as transdermal patches or subcutaneous opioids are reserved for patients unable to take oral opioids or with unstable analgesic requirements, and should be initiated with specialist input. Opioids should be part of a multimodal pain management approach, including non-opioid analgesics like paracetamol and NSAIDs where appropriate.

This approach aligns with NICE guidance on perioperative and palliative care opioid prescribing, emphasising cautious initiation, patient education, regular review, and minimising opioid exposure in acute pain management in primary care.

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