QuestionSBA
QuestionChoice
Whilst bisphosphonates may well be used in the treatment of bone metastases, stopping the patient's pain relief is unnecessary and agonising for the patient
10035960
d
Stop all pain relief and start pamidronate
QuestionChoice
The current regimen is not sufficient to control her pain as she has used 5 breakthrough doses in a day, it needs to be increased.
10035961
e
Continue with the same dose of morphine
QuestionChoice
Whilst radiotherapy is a treatment option for bone metastases, this will likely require careful planning and may not occur immediately, stopping the patient's pain relief is unnecessary and agonising for the patient.
10035959
c
Stop all pain relief and refer for radiotherapy
QuestionChoice
This may be overzealous at this stage as we are more than doubling her current pain relief and we must titrate up to find the optimal regimen for the patient. High doses of opioids can be associated with greater side effects profile including respiratory depression.
10035958
b
Increase morphine sulfate to 120mg BD with 40mg oramorph breakthrough dose
QuestionChoice
This is correct. The patient's regular analgesia regimen is not strong enough. The patient has used 60mg + 6(10mg = 1/6th of her total 120mg for breakthrough dose)= 120mg in a day. Therefore her new regimen should include 120mg as regular pain relief with a breakthrough dose of 1/6th of 120=20mg of oramorph.
10035957
a
Increase morphine sulfate to 60mg BD with 20mg oramorph breakthrough dose
QuestionComment
I thought you're meant to increase by 30-50%
60378
User
subscriber
Medstudent01
Concept
Chapter
2693
6029
WHO Pain Ladder
Topic
225
Oncology and Palliative Care
19595
Breakthrough analgesia should typically be dosed at 1/6th of the total daily dose of the patient’s regular pain medication to provide relief for episodes of severe pain between regular doses.
A 69-year-old woman with metastatic breast cancer is admitted to the oncology ward due to new bony metastases causing her an incredible degree of pain. She is commenced on co-codamol, ibuprofen and morphine sulfate (Continus) 30mg BD. She has used 6 breakthrough doses in the last 24 hours.

What is the most appropriate management of her pain relief?
a