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Patients switched from morphine
Case 1
A 48-year-old patient, presented with breast carcinoma and left brachial plexopathy. She had constant pain in her lower left abdomen, left buttock and left anterior thigh when standing. She was treated with prolonged release (PR) diclofenac (75 mg twice-daily), amitriptyline (50 mg at night) and PR morphine (60 mg twice-daily), as well as immediate release morphine, as required, for breakthrough pain. However, when her dose of PR morphine was increased above 120 mg/day, she experienced intractable nausea and confusion. She was therefore switched from PR morphine to OxyContin® tablets 40 mg twice-daily. Her dose of OxyContin® tablets was titrated to 100 mg twice-daily and she responded well, with less pain and fewer side effects compared with PR morphine.
Case 2
A 69-year-old patient, presented with metastatic ovarian cancer. She was in constant, severe pain and was treated with PR diclofenac (75 mg twice-daily), amitriptyline (50 mg at night) and PR morphine (60 mg twice-daily), as well as immediate release morphine, as required, for breakthrough pain. The dose of 60 mg PR morphine twice-daily did not provide adequate pain control, but dose titration led to nausea and confusion. She was therefore switched to OxyContin® tablets (20 mg twice-daily). Her dose was titrated to 80 mg twice-daily and she achieved excellent pain control with no nausea or cognitive impairment.
Patients switched from other opioids
Case 3
A 55-year-old patient, presented with adenocarcinoma of the lung and metastases in the brain and skull. He was treated with diamorphine (in combination with haloperidol via a syringe driver) for intractable headache. However, this medication made him very drowsy and he was switched to OxyContin® tablets 20 mg twice-daily. After titration of the dose to OxyContin® tablets 30 mg twice-daily, his pain was well controlled and he was discharged.
Case 4
A 69-year-old patient, presented in pain with metastatic ovarian cancer. She was started on morphine, but because of side effects, her dose could not be titrated to achieve adequate pain control. She subsequently underwent a stellate ganglion block, but this was unsuccessful. Methadone (15 mg twice-daily) provided adequate pain control but she experienced unacceptable cognitive impairment. She was therefore switched to OxyContin® tablets at a starting dose of 20 mg twice-daily. The dose was titrated to 80 mg twice-daily and she had excellent pain control with no cognitive impairment.
To view more case studies on cancer-related pain, please click here
To view case studies relating to post-operative pain, please click here.