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Breakthrough cancer pain — FRCA Final MCQ

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ModeratePain MedicineBreakthrough cancer painFRCA Final

A 68-year-old man with metastatic prostate cancer takes modified-release morphine 60 mg twice daily with good baseline pain control. He now has predictable breakthrough pain on movement several times daily and normal renal function. What is the most appropriate pain management?

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Correct answer: E — Prescribe immediate-release morphine approximately one sixth of the 24-hour dose as rescue

Breakthrough cancer pain in a patient established on oral morphine is commonly treated with immediate-release morphine around one sixth of the total daily dose, then titrated. Large background dose increases without rescue therapy may cause toxicity. Pethidine is inappropriate for repeated cancer pain use. Methadone can be valuable but requires specialist expertise due to variable kinetics and interactions.

Reference: NICE cancer pain/opioid guidance; BNF; Faculty of Pain Medicine Core Standards