Page 39 - CPG - Clinical Practice Guidelines - Management of Cancer Pain

Management of Cancer Pain (Second Edition)
Example 2:
Patient is on aqueous morphine 5 mg 4-hourly and takes no rescue
doses but still has uncontrolled pain.
Total 24h morphine = (5 mg x 6) = 30 mg/24h
NEW 24h morphine = 30 mg + 25% of 30 mg (7.5 mg) = 37.5 mg
New 4-hourly dose: 37.5 mg/6 = 6.25 mg (rounded down to nearest mg)
Prescription: aqueous morphine 6 mg 4-hourly and 6 mg PRN
• Maintenance
Once pain control is adequate and a stable effective dose has been
determined, long-acting opioid formulations may be considered for
ease of administration.
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hours, while transdermal fentanyl patches are applied every 72 hours.
Example 3:
Patient’s pain control is adequate with aqueous morphine 7.5 mg
4-hourly and no additional doses required for breakthrough pain.
Total 24h morphine = 7.5 mg x 6 = 45 mg
Convert to Tab morphine SR = 45 mg/2 = 22.5 mg
Prescription: Tab morphine SR 20* mg BD (morphine SR available
in 10 mg & 30 mg tabs)
*Rounding of the prescription dose is based on drug strength availability.
In patients presenting with severe cancer pain, rapid titration using
parenteral opioids may be useful in controlling patient’s initial pain. Refer
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{ should be titrated according to individual analgesic response and
occurrence of AEs
{ should be initiated at the dose of 5 - 10 mg 4-hourly using the oral
IR formulation
{ should be started with a lower dose of 2.5 - 5 mg 4 - 6-hourly of the IR
formulation in the elderly
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presenting with severe cancer pain for initial pain control. 9
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management. 9
• Alternative methods of administration:
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{ continous parenteral opioid infusion
• Long-term use of opioids must not be abruptly discontinued to avoid
withdrawal. Tapering opioid therapy must be conducted in a stepwise
fashion, involving patients throughout the process.
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