Opioid Administration and Pain Management in the Terminally Ill Cancer Patient: Case study of a patient in the terminal phase of breast cancer.

This case study is based on Ms. D, a 48-year-old married woman diagnosed with Bilateral Breast Cancer. She underwent a bilateral mastectomy 4 years ago. Lymph involvement was noted at the time of the surgery. Recent metastases of the bone has been diagnosed and she is in the terminal phase of the disease process. Up to this point, she has been on a regimen of Oxycodone 5 mg P.O. every 6 hours as needed for pain, Zantac 150mg P.O daily for heartburn, Docusate 100mg P.O. twice a day to promote bowel movements, Celexa 40mg PO daily for depression and enteric coated aspirin 81mg PO daily for prophylaxis of transient ischemic attacks and MI. She remains in her home and is receiving care at home.
Ms. D has complained recently of significant increased pain and trouble sleeping, most likely due to the bone metastases in the area of the lumbar spine. She has stated that the pain has dramatically decreased her quality of life recently also. She has expressed the desire to remain at home during the terminal phase of her disease, but needs more adequate pain management to preserve her quality of life for as long as possible. She is married and her husband is very loving and supportive of her desire to stay in the home during this phase. He has voiced some concerns about drug dependency if the patient were to receive stronger pain medication.
I have contacted her physician and discussed her need for better pain management. I suggest Morphine 10 mg tablets PO every 4 hours. This is to be taken with food or milk (Davis Drug Guide 2012). The morphine should be more effective on the pain then the Oxycodone. I also suggest Morphine 5 mg subcutaneous every 4 hours as needed for breakthrough pain (Davis Drug Guide 2012), and Ibuprofen