Opioid Dose Reduction When Pain Improves — SCE Palliative Medicine MCQ

Correct answer: B — He may be on more opioid than he needs — sedation with good pain control suggests the dose can be cautiously reduced while maintaining analgesia

The correct answer is B. This patient’s pain is well controlled (2/10) yet he experiences excessive sedation—indicating that the opioid dose may be excessive for current analgesic needs. NICE CG140 recommends that in patients with persistent or moderate-to-severe central nervous system side effects and adequate pain control, dose reduction should be considered. Reducing the dose may preserve analgesia while alleviating sedation and improving quality of life. Option D (caffeine) only masks symptoms without addressing root cause. Option E (methylphenidate) is not routinely mandated and is second-line. Option C (complete cessation) risks undertreating pain. Option A (increasing dose) would worsen sedation. Thus E is the only defensible choice within UK practice.

Reference: NICE Clinical Guideline 140: Palliative care for adults—strong opioids for pain relief; Recommendation 1.1.25 (dose reduction if pain is controlled) and Managing side effects: Drowsiness section (2012, reviewed 2024), https://www.nice.org.uk/guidance/cg140/chapter/Recommendations