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Cancer Pain Escalation — RACP Adult Medicine MCQ

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HardGastroenterologyCancer Pain EscalationRACP Adult Medicine

A 70-year-old with metastatic pancreatic cancer has continuous severe nociceptive pain despite paracetamol and regular tramadol. He can swallow, has normal renal function and has never received a strong opioid. Which escalation is the best initial strategy?

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Correct answer: CStart immediate-release oral morphine, prescribe rescue doses and laxative prophylaxis, then review titration at early follow-up

The best answer is “Start immediate-release oral morphine, prescribe rescue doses and laxative prophylaxis, then review titration at early follow-up”. In an opioid-naive person with severe cancer pain who can swallow, immediate-release oral morphine permits safe dose finding; prescribe rescue doses and constipation prophylaxis. Transdermal fentanyl is poorly titratable in opioid-naive patients, modified-release morphine is not the initial titration choice, and pregabalin does not treat nociceptive pain.

Reference: Australian Prescriber: Rational prescribing in community palliative care: https://australianprescriber.tg.org.au/articles/rational-prescribing-in-community-palliative-care.html Australian RACP: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination