Pain - review letter
RAG rating
Document type
Primary Care prescribing resource
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing


Sample Letter Inviting Patients for Review

Dear Patient

We are currently undertaking a review of prescriptions for medications collectively known as opioids, which are prescribed to patients within our practice.

An opioid (sometimes called an opiate) is a strong painkiller, such as morphine, oxycodone, fentanyl, buprenorphine, tramadol, codeine and dihydrocodeine.

New national guidance (1) requires that all patients prescribed high dose opioid painkillers for long term pain must be reviewed to ensure that their treatment is effective and appropriate.

This review is needed because although opioids are very effective at treating short-term pain and end of life pain, there is little evidence that they are helpful for managing long-term pain. However, some people may obtain good long-term pain relief with opioids if the dose can be kept low and they are only used occasionally. It is difficult to identify these people at the start of treatment.

There are some risks associated with long-term opioid use – opioids can:

  • sometimes make pain worse
  • cause side effects to the intestines and the stomach
  • make the body feel addicted to, or dependent on them so if you miss a dose you feel a bit jittery and anxious
  • increase the risk of falls
  • increase the risk of overdose and death, especially if too much medication is inadvertently taken with alcohol, pregabalin, gabapentin or benzodiazepines like diazepam.


We are now writing to all patients, who from our records, have received a number of opioid prescriptions above a specific dose for at least three months.

The practice will contact you to make an appointment to review your medication.

At this appointment we will carry out a full assessment of your pain issues and a medication review. We will be able to discuss the benefits and risks associated with the medications prescribed for your long-term pain and explore if there are any alternative treatment options to help you manage your pain effectively.

Please don’t change your medication until you have spoken to somebody from the team who will guide you through adjusting the dosage, if this is appropriate.

In the meantime, we enclose leaflets on managing long term pain – ‘Ten Footsteps - Your Journey to Living Well with Pain’ and ‘Driving and Pain -information for patients’ (2,3). We hope you will find these helpful.

Yours sincerely


1 NHS England and NHS Improvement South West » Opioid prescribing for chronic pain

2 Ten Footsteps to Living Well with Pain

3 Faculty of Pain Medicine – Driving and Pain
Version number
Developed by
Approved by
Date approved / updated
July 2022
Review date
This HWE APC document is based upon the information available at the time of publication. This document will be reviewed upon request in light of new information becoming available.
Superseded version