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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.
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