Approach to using a regular oral opioid for background pain in palliative care

Australian Adult Cancer Pain Management Group

If opioid therapy is indicated, see Choice of opioid for pain in palliative care and Starting an opioid for pain in palliative care for guidance on opioid choice and considerations when starting opioid therapy.

The usual approach to regular oral opioid therapy for background pain in palliative care is to use a modified-release formulation.

An alternative approach is to use an immediate-release formulation regularly; for example, if a patient has swallowing difficulties or only has access to an immediate-release formulation and a delay in obtaining a modified-release formulation is expected (eg in rural settings).

Note: For ongoing opioid therapy, prescribe regular and breakthrough doses of opioids.

Regardless of the approach taken, also prescribe an immediate-release formulation, ideally of the same opioid, for breakthrough pain or incident pain.