A 72-year-old man with prostate cancer, bony metastases, and a prognosis of 4-6 weeks is in a hospice. He has worsening pain despite regular Morphine ...

Question

A 72-year-old man with prostate cancer, bony metastases, and a prognosis of 4-6 weeks is in a hospice. He has worsening pain despite regular Morphine Sulphate Modified Release 60 mg BD and Morphine Sulphate immediate release 10 mg PRN (using 4-5 breakthrough doses per day). What is the MOST appropriate next step in pain management?

Accepted Answer

Calculate total 24-hour Morphine use, increase the modified-release dose by 30-50%, and adjust the breakthrough dose accordingly

Answer

Double the modified-release dose to 120 mg BD immediately

Answer

Switch to Paracetamol alone as Morphine is clearly not working

Answer

Start a Fentanyl patch without adjusting the Morphine dose

Answer

Add an NSAID for bone pain

uk-dgm MCQ (SBA): Opioid Dose Titration in Palliative Care