MORPHINE-BREAKTHROUGH PAIN

Breakthrough pain occurring between 12-hourly doses is treated with immediate-release oral morphine mixture, taken as often as required to control pain, and not by increasing the frequency of the controlled-release preparation.

The dose of oral morphine mixture used for breakthrough pain is the same as the 4-hourly dose or one-third of the 12-hourly dose. Some patients prefer to continue using their previous medications, such as Codral Forte or Panadeine Forte, for breakthrough pain; whilst the use of multiple opioid drugs is not ideal therapy, such treatment is acceptable providing it produces satisfactory pain control.

A small proportion of patients consistently develop breakthrough pain towards the end of each 12-hour dosing period. For patients taking MS Contin this problem can be overcome by giving the medication on an 8-hour schedule; more frequent administration is not recommended. The dose for 8-hourly administration is calculated with the 24-hour dose being divided by three. Kapanol has different pharmacokinetic properties and administration more frequently than

12-hourly is not recommended.

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Pain Relief/Muscle Relaxers