Page 37 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
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• Oral morphine is the preferred choice in moderate to severe cancer
pain.
{ Immediate-release oral morphine should be made available in all
healthcare facilities.
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• Transdermal fentanyl should only be used when opioid requirements
are stable.

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• Initiation
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persistent pain, an IR formulation should be given every four hours
to control background pain and with similar doses given up to every
hour as needed for breakthrough pain. Patients who have been taking
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opioid initiation if these agents provide additional analgesia and are not
contraindicated.

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A dose of 5 mg 4-hourly of IR oral morphine in opioid-naive patients has
been shown to be a safe and effective starting dose (p<0.01). Opioid-
naive patients are those not chronically receiving opioid analgesic on
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Patients already on regular weak opioids (tramadol or dihydrocodeine)
may have morphine initiated at a dose equivalent to that of the weak
opioid (refer to 7DEOH ). A lower starting dose of 2.5 mg 4 - 6 hourly of
IR oral morphine has been shown to be effective (p<0.01) and safe in
elderly or frail patients.

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