In the article 'Criteria for adapting national cancer pain guidelines for local use' (Guidelines in Practice, July 2000) the 'typical' algorithm shown in Figure 1 showed slow-release morphine ahead of transdermal fentanyl.
The benchmarking review carried out on behalf of the National Council for Hospice and Specialist Palliative Care Services found that submitted algorithms more often placed transdermal fentanyl before slow-release morphine.
However, it is my view that, in clinical practice, slow-release morphine would be the first-line treatment once pain was controlled and that positioning this treatment second might suggest otherwise to those writing their own algorithms.
Council's publication Are Cancer Pain Guidelines Good Enough? Bench-marking Review of Locally Derived Guidelines on Control of Cancer Pain shows transdermal fentanyl above slow-release morphine, in line with the findings of the review.
Professor Ilora Finlay, Professor of Palliative Medicine, University of Wales College of Medicine
I have recently read the RCP's guidelines for stroke, as featured in Guidelines in Practice (April 2000, Vol 3) and they are frankly superb.
They involve carers and their patients to boot, which I feel is not only laudable but actually obligatory.
All GPs should be encouraged to read these guidelines, or at least a digest stroke is a Cinderella area of medicine that is grossly undermanaged.
Dr John Cannon, GP, Suffolk
I accessed the eGuidelines website today and found it extremely easy to navigate.
I am a fan of Guidelines in Practice, but having the guidelines available in one place, together with all the news on the development of new guidelines etc made it much easier and more time effective. Overall I found the site extremely useful.
Suzanne Crabtree, Clinical Effectiveness Facilitator, Mansfield District PCT
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