Expert: Margot RN BScN CGN - 8/19/2008

Question
I am caring for my wife who is under hospice care for 4 weeks. She was diagnosed with stage 4 lung cancer 18 months ago. After aggressive chemo, the cancer began to spread. The oncologist thought it was time for hospice. The hospice Dr immediately switched her from the 270 mg of oxy contin  daily to increasing doses of morphine er and liquid morphine. We are currently taking 90mg of morphine er 4 times a day and I am giving her 21 mg of liquid morphine 4-5 times a day. I can give her 42 mg of liquid morphine at a time and it still doesn't seem to touch the pains she is now having in her chest. Where do you go from here? some days I see the pain she is in and think I should just give her 400 mg of morphine er to see if that would help but I am afraid of overdosing her. She has been on this strong narcotic regimen for years. Previously she had cluster migraines and was taking 50mg of lortab daily. Has she just built up an extremely high tolerance?

Answer
Hi Don and thanks for writing,

I think your wife has built up tolerance and her current medication regime is simply not working so you need to talk to her family doctor or oncologist about switching to another medication – no one should be in pain with all the medications we have today.  You might even ask for a Pain Specialist as a second opinion.

You may need to ad adjunctive medications to help the narcotics work more effectively, or you may even need to switch to different narcotics.

Wishing you all the best,
Margot