Pain control is a process that takes time. Start low
and go slow and steady (continue titrating the drug until pain is completely
controlled) when doing opioids in older adults.
•
The right dose of the opioid is whatever dose it takes to palliate pain
without intolerable side-effects.
•
Increase (or decrease) opioid doses by 25% of the total dose per day
as tolerated. If increasing dose by 50% wait for 48 hours before the next
basal dose increase and have sufficient short-acting pain medications available
for break through pain.
•
Order opioids by the hour, by mouth (i.e. 8 hours,
Q 6 hours instead of tid, qid)
•
Tolerance and physical dependence associated with opioids are attributes
that usually accompany chronic opioid use. These attributes should not be
thought of as side effects and patients and families should be educated
about these issues.
•
Patients taking opioids for pain control are unlikely to develop psychological
addiction. The odds of a terminally ill patient with cancer pain becoming
a "recreational drug user" or a "drug addict"
is remote.
