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Therapeutic Value of Memorial Walks — SCE Palliative Medicine MCQ

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HardBereavementTherapeutic Value of Memorial WalksSCE Palliative Medicine

A patient taking oral modified-release morphine 30 mg twice daily has persistent inadequately controlled background pain and has needed six effective 10 mg immediate-release rescue doses in the last 24 hours. There is no opioid toxicity, and the rescue use is representative rather than a one-off flare. Which new regular and breakthrough regimen is arithmetically consistent with the guidance?

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Correct answer: E — Modified-release morphine 60 mg twice daily with 20 mg immediate release as needed

Regular morphine is 30 mg twice daily = 60 mg/24 hours. Six effective 10 mg rescue doses add 60 mg, giving a representative total of 120 mg oral morphine/24 hours. Dividing that total into two modified-release doses gives 60 mg twice daily. One-sixth of 120 mg is 20 mg for immediate-release breakthrough. This is same-drug titration for persistent background pain, not automatic escalation after isolated incident pain and not opioid rotation, so a cross-tolerance reduction is not applied. Reassess pain mechanism, toxicity and ongoing rescue use after the change.

Reference: Scottish Palliative Care Guidelines: Pain management: https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/pain/pain-management/