Drive to cut unnecessary patient pain

Effective paiinkillers can be injected

Doctors' leaders are to issue guidelines to try to reduce the number of patients who suffer pain unnecessarily.

The advice, from the Royal College of Physicians, has been drawn up after fears that the high profile given to cases such as that of serial killer Dr Harold Shipman may have made doctors more reluctant to use painkilling drugs such as morphine on their patients.

Some doctors worry that they may unintentionally shorten life while alleviating pain, or have their motives misinterpreted.

Patients might not be having their pain controlled as well as it could be

Dr Anne Naysmith, palliative medicine expert

However, morphine and other drugs are very safe if correctly used and can ensure patients have a comfortable death without shortening life.

Dr Anne Naysmith, a consultant in Palliative Medicine at St Charles's Hospital, London, helped to formulate the guidelines.

She told BBC News Online: "After all the adverse publicity surrounding the Shipman case we are concerned that doctors might have become a little defensive, and a little more hesitant about using morphine to help people who are in serious pain.

"As a result patients might not be having their pain controlled as well as it could be."

Shortening life

While it is illegal for a doctor to set out to end a patient's life, they can administer drugs which they know will shorten life if the primary intention is to reduce pain. This is known as the doctrine of double effect.

However, Dr Naysmith said morphine, when used carefully, was a very safe and effective painkiller.

It would not shorten life if dose was carefully adjusted to combat levels of pain.

She said the guidance would be widely circulated to GPs and other doctors who treated seriously ill patients, but who were not specialised in palliative care.

The guidance is designed to ensure that patients get the most appropriate kind of pain relief and the correct dosage.

It covers the following topics:

• caring for the dying patient and when to talk about dying
• matching the drugs to the patient's pain
• using morphine before the very last days of life
• what to do if the morphine isn't working
• which way is best to give the drugs
• when to seek help from a specialist team

The guidelines state that difficult decisions about drug treatment, particularly near the end of life, should always be made in discussion with the family.

"Their knowledge of the patient can be used to help to make the decision in the way the patient would probably have wished."

Doctors are also advised that if they do not have specialist skills in certain aspects of pain relief, then they should seek expert help.

Approximately two thirds of terminally ill patients experience pain.