Pain from terminal conditions usually increases over time; there is no ceiling or maximal opioid dose. Titration of opioids is an invaluable pain management skill to master. It is important to remember the following facts:
Immediate-release morphine reaches its peak effect after 45 to 60 minutes when taken orally, after 15 to 30 minutes when delivered SC, and after five to 15 minutes when given by IV.
If pain is not relieved within these peak timeframes, an additional dose should be given.
In general, increase dose by 25% to 50% for mild-to moderate pain and 50% to 100% for moderate-to-severe pain.
Short-acting medications (e.g., morphine, oxycodone) can be increased safely every two hours, long-acting preparations (e.g., MS Contin, Oxycontin) every 24 hours and transdermal fentanyl patches every 72 hours.
Patients with renal insufficiency or hepatic disease may require a smaller increase in dose or longer titration interval.