MORPHINE-INCIDENT PAIN AND ADJUSTMENT OF DOSE

Incident pain is pain which occurs only in certain circumstances, such as after a particular movement or on standing. Incident pain is treated in the same manner as breakthrough pain. If the incident pain can be predicted, the additional treatment can be given prophylactically, 30 or 60 minutes earlier, to lessen or prevent the pain.

Adjustment of dose. If more than occasional doses of morphine mixture are required for breakthrough pain, the 12-hourly dose of controlled release morphine is increased by the amount of extra morphine the patient required during each 12 hour period. Patients with pain worse at night and those troubled by sedation during the day may benefit from a higher dose in the evening. For example, a patient might receive 20 mg in the morning and 30 mg at night, or 200 mg in the morning and 300 mg at night.

• The correct dose of morphine is that which controls the pain whilst causing tolerable side effects, titrated for each individual patient.

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Pain Relief/Muscle Relaxers