Question

A 72-year-old woman with metastatic pancreatic cancer has severe pain despite high-dose sustained-release morphine 200 mg twice daily. She is drowsy and has myoclonic jerks. Renal function is moderately impaired. What is the most appropriate next step in palliative pain management?

Accepted Answer

Switch to an equianalgesic dose of fentanyl or hydromorphone and manage symptoms

Answer

Increase morphine dose further to achieve analgesia

Answer

Add benzodiazepines to control myoclonus and continue morphine

Answer

Cease all opioids and use Paracetamol only

Answer

Refer urgently for surgery to remove the primary tumour

Practice question

A 72-year-old woman with metastatic pancreatic cancer has severe pain despite high-dose sustained-release morphine 200 mg twice daily. She is drowsy and has myoclonic jerks. Renal function is moderately impaired. What is the most appropriate next step in palliative pain management?