Benzodiazepines

Morphine

Opioid Misuse

SIGN issued guidance on the control of pain in adults with cancer in 2008. Selected points

• the breakthrough dose of morphine is one-sixth the daily dose of morphine
• all patients who receive opioids should be prescribed a laxative
• opioids should be used with caution in patients with chronic kidney disease
  • oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
  • if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred

When increasing the dose of opioids the next dose should be increased by 30-50%.

In addition to strong opioids, bisphosphonates and radiotherapy, denosumab may be used to treat metastatic bone pain.