Difficult pain

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Abstract
Pain that responds poorly to opioids The European Association for Palliative Care guidelines on the use of morphine and alternative opioids in cancer pain confirm oral morphine as the opioid of choice for moderate to severe pain. If the pain is uncontrolled with a dose of morphine that gives the patient intolerable side effects, suggested measures include exploring psychosocial issues, managing the side effects, reducing the dose of opioid, switching to an alternative opioid, or changing the route of administration. The use of adjuvant drugs or co-analgesics may be appropriate. Many such patients will have neuropathic pain.

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