Oral opiate analgesia
Morphine is the preferred strong oral opiate.
Two formulations of morphine are sufficient:
- immediate release e.g. oromorph
- controlled release e.g. MST Continus
The required dose of analgesia is determined by the following method:
- decide on an appropriate dose of immediate release morphine (5-10 mg) which is given four-hourly
- break-through pain is controlled with the same dose which may be given as frequently as once hourly
- each day the four-hourly dose is adjusted according to the total morphine requirement of the previous day
- once pain is controlled with immediate release morphine, the same dose is prescribed in two divided doses as a controlled release preparation
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