CDHB
Pain is a symptom that requires thorough evaluation and appropriate management. The aim is to control pain adequately while diagnosis and treatment of the primary disease continues. Therapy depends on:
Individualize therapy - the optimum dose of analgesic can vary quite widely between similar patients and in the same patient from time to time. Titrate agent and aim for minimum side effects. Do not change a drug until it has been fully evaluated.
Drug metabolism and excretion may be reduced in liver and renal disease and in the elderly. Dose frequency may therefore need to be reduced or changed to a more appropriate analgesic. All opioids should be given cautiously to patients with respiratory disease, although this is less of an issue in chronic/persistent pain compared to acute pain. Morphine may cause bronchospasm in addition to respiratory depression.
Note: If the patient is already enrolled on the Methadone programme, follow the guidelines since the treatment of these patients is covered by legislation.
Topic Code: 1568