Introduction

Opioids are used for pain and breathlessness. Most patients with palliative care needs respond well to titrated oral morphine.

• For frail/elderly patients, consider a lower starting dose of opioid.
• Seek specialist advice if the patient is in moderate to severe pain with frequent use of breakthrough medication, in other words more than three doses in 24 hours.

A small number of patients may need to be changed to another opioid if:

• oral route is not available
• pain is responding but the patient has persistent intolerable side effects (consider reducing the dose and titrating more slowly or adding an adjuvant analgesic before changing opioid)
• moderate to severe liver or renal impairment
• poor compliance with oral medication
• complex pain (consider adjuvant analgesics/other pain treatments).