Pain is commonly observed in the last few days of a palliative illness.
- Prescribe an opioid for pain management. Consider:
- If pain is present, administer PRN opioid dose
- Assess effectiveness of administered medicine and continue administering opioids as required
- Review current opioid dose:
- If the patient is using regular opioids and is unable to swallow, consider converting regular oral opioids to appropriate SC dose administered by CSCI using syringe driver over 24 hrs
- If the patient is very distressed and/or if multiple PRN opioids have been administered in the previous 24 hours to manage pain, consider:
- calculating the total PRN opioid dose over the previous 24 hours and add to syringe driver
OR
- titrating up the opioid dose administered by syringe driver in previous 24 hours by 30%.
- If opioid patch in situ consider:
- continuing patch at same dose and giving opioid PRN SC dose for breakthrough pain (may require advice from specialist palliative care team)
OR
- converting patch to appropriate SC opioids dose administered by CSCI using a syringe driver over 24 hours.
- Ensure order written for PRN dose.
- PRN order = 10% of total daily SC dose, every 2 hrs
- If pain persists, administer PRN opioid dose.
- Assess effectiveness of administered medicine and continue administering opioids as required.
Prescribing considerations
- Review patient regularly
- If greater than 3 doses of PRN opioids are required for breakthrough pain over 24 hour period, request prescriber review to consider changes to medication and syringe driver orders.
- Use a syringe driver if regular dosing is required
- Check availability of medicines through the patient’s usual pharmacy
The medicines listed throughout this app are in line with those endorsed by Caring at Home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM) within the Community End-of-Life Medicines List (168kb pdf).
Page updated 19 July 2018