The term “cancer pain” also includes pain due to terminal illness.
The same steps as given in section Analgesia for chronic non-cancer pain should be followed with the following exceptions:
- Morphine:
- There is no maximum dose of morphine that may be needed.
- Concerns regarding addiction should not compromise adequate pain control with opioids when used to treat terminal illnesses.
- For terminally ill patients on slow release morphine, it is advisable to still prescribe morphine syrup for breakthrough pain or for painful procedures.
Note:
- Opioid–induced hyperalgesia is defined as increasing pain sensitivity in patients chronically exposed to opioids without any new causes for pain. Increasing doses of morphine paradoxically result in increased pain, often with features of neuropathic pain such as hyperalgesia or allodynia.
- It can be managed by switching to methadone, in consultation with a specialist familiar with the use of this agent.
Bisphosphonates may be considered for metastatic bone pain – refer to the Tertiary and Quaternary EML (specialist management/consultation).