Background and Aims
The British National Formulary (BNF) is considered to be a core reference text in the United Kingdom regarding prescribing within the National Health Service with the first being published in 1981. The aim of this study was to review the advice on opioid prescribing in chronic pain over the last 38 years.

Methods
Each edition of the BNF was reviewed. Morphine sulphate was examined within the text and the guidance for its use in the context of chronic pain was analysed.

Results
Since its introduction, 76 editions of the BNF have been published and each were reviewed.  The indication of chronic pain for morphine sulphate was first introduced in edition 11 in 1986. Then, morphine sulphate was recommended in chronic pain at a dose of oral 5-20mg, regularly at 4 hourly intervals.  This equates to a maximum of 120mg per day which is the current maximum morphine dose by the Faculty of Pain Medicine. The BNF 54 in 2007 changed the recommendation to 5-20mg at 4 hourly intervals as required. In 2010, the BNF 60 further reduced the recommended dose to 5-10mg at 4 hourly intervals.  This equates to a maximum total daily dose of 60mg.

Conclusions
It is remarkable that the BNF identified in 2010 the need for a lower dose of morphine for chronic pain before the start of the opioid crisis. Perhaps the foresight of this publication will be reflected in national guidance soon.

IS THE BRITISH NATIONAL FORMULARY THE BIBLE OF CHRONIC PAIN MANAGEMENT?