Opiates in palliative care

Strong opioids ,in particular morphine are the principal treatments for pain related to advanced and progressive disease ( NICE 2012 )

Pain is common in advanced and progressive disease and up to 2/3rd people with cancer will experience pain that needs strong opiates Opioids are available in different forms ( oral / transdermal / transmucosal / injectables ) and pharmacokinetics of the various opioids are very different and there are marked differences in bioavailability , metabolism and response among patients Opioids also come with different release characteristics◘ Modified release ( MR ) used for background pain over a 24 hr period◘ Immediate release ( IR ) preparations for as required breakthrough painoral IR morphine has an effect within 20-30 mins and peak in about 60 mins Individual selection for each patient and effective and safe titration -has a significant impact on pain control When deciding on initial dose of morphine - take into account ○ previous / current analgesic use○ renal function○ co-morbidities○ age○ individual circumstances It is known that risk of harm increases substantially at doses above an oral morphine equivalent of 120 mg / day with no increased benefit and this is often used as a cutoff when...