- Continue current regimen of MS Contin and MSIR 30 mg and add an NSAID for additional analgesia without worsening constipation from with higher doses of opiates.
No - non-opiate analgesics are indicated for mild-moderate pain (click here to see the World Health Organization Step-Ladder Approach to Treatment of Pain). While sometimes useful co-therapy with opiates, unlikely to be very effective now with level of pain and doses of opiates required.
- Continue MS Contin and, in place of oral MSIR, begin parenteral (IV) morphine for breakthrough.
Yes - parenteral short-acting opioid will allow more rapid dose titration and control of pain.
- Increase MS Contin dose to 120 mg Q12hours and continue current dose of MSIR for breakthrough pain.
Maybe - A higher dose of MS Contin will be improve pain control over time but will take time (how much) to be effective.
- Continue MS Contin but discontinue MSIR and start pentazocine (Talwin ®), a mixed agonist-antagonist for breakthrough pain.
No - there is little if any indication for use of mized agonists-antagonists for treatment of pain in palliative care and they should never be administered to patients on pure agonists.
- Discontinue MS Contin and start Fentanyl patch with MSIR for breakthrough.
No - there is no indication to change opiate type and slow onset of action of transdermal fentanyl (13-24 hours) will make rapid control of pain more difficult.