A patient reports increasing cancer pain on her current opioid regimen along with recent cancer progression. Up to 3 weeks ago she had good pain control but since then, the pain has gradually worsened. She reports a pain level of 8/10 most of the day and difficultly falling and staying asleep due to pain. The patient has no renal, liver or pulmonary compromise. In considering how to dose escalate her opioid, which one of the following is a reasonable guideline.
a) Dose escalate by 10-25%
b) Dose escalate by 25-50%
c) Dose escalate by 50-100%
d) Dose escalate by 100-200%
Answer: c.
Moderate to severe pain, as characterized by both a high pain score and functional impairment, requires a significant dose escalation. A reasonable recommendation is 50%-100% for moderate to severe pain, and 25-50% for mild to moderate pain, with reduction if there is renal or liver disease and impaired respiratory function.
See Fast Fact #20: Opioid Dose Escalation
