As-required oral opioids for intermittent pain in patients with palliative care needs who do not already take a regular opioid
For management of acute pain, including severe acute pain (which is a medical emergency), see Acute pain in palliative care.
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.
For initial as-required therapy with an immediate-release opioid for intermittent pain in patients with palliative care needs who do not already take regular opioid therapy, or are just starting regular opioid therapy, use:
1morphine immediate-release 2 to 5 mg orally, 1-hourly as required12. For patients who are older, frail or cachectic, use the lower end of the dose range and consider more prolonged intervals between doses. Monitor response and review therapy if 3 or more doses are needed in 24 hours; see Monitoring therapy for breakthrough pain morphine
OR
1oxycodone immediate-release 1 to 3 mg orally, 1-hourly as required3. For patients who are older, frail or cachectic, use the lower end of the dose range and consider more prolonged intervals between doses. Monitor response and review therapy if 3 or more doses are needed in 24 hours; see Monitoring therapy for breakthrough pain. oxycodone
The dosage regimens above specify the maximum dose frequency of oxycodone and morphine, based on the expected time to peak effect of the dose. Individualise the dosage regimen by considering the care setting, and the patient’s pain severity and stability, and goals of care.