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Loss of control of pain

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

There is no upper limit for strong opiates in palliative care but if the pain is not controlled despite rapidly escalating doses consider:

  • fracture or impending fracture
  • hypercalcaemia, a common cause of worsening bone pain
  • urinary retention
  • constipation
  • compliance: patients may dislike opiate owing to nausea, sedation, confusion, groundless fears or uncertainty as to the dose
  • failure to absorb eg vomiting
  • neuropathic origin of pain
  • new or other pathology, related or unrelated to cancer such as angina
  • depression or psychological distress

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