The main reference points to keep in mind for the use of the rescue dose are:
1. Since pain in a cancer patient is as an emergency, the appearance of acute or paroxysmal pain must be taken into account and addressed with a fast-acting / short-acting morphine.This analgesic supplement between two doses of background analgesia is called the rescue dose.
2. The rescue dose is prescribed and used at the same time as opioid background analgesia. It has many decisive advantages:
- Avoids insufficient pain control, while starting with a low dose of background analgesia.The patient will get relief for each bout of pain.
- Allows the background analgesia to be progressively increased and avoids over-dosing early on. Repeatedrequests for a rescue dose by the patient throughout the day are equivalent to giving a higher morphine dose overall and leads to a “stronger” treatment dose over 24 hours.
3. By interacting with the background analgesia, the rescue dose is integrated into the overall morphine-based analgesia approach. The repeated occurrence of pain often highlights a need for a higher base analgesic opioid level. The intake of three rescue doses over 24 hours is often a sign that the background analgesia should be increased by about 30%. But there is no rush to increase the background dose because of the availability of rescue doses and the effectiveness can be evaluated over a few days without the patient suffering from pain.A controlled approach where the base level is increased slowly is particularly wise when long half-life opioids are used for background analgesia treatment.With the latter, it will take some time before the patient feels a change when the dose is increased.Conversely, during the terminal phase of the disease, the base opioid level often needs to be increased frequently and quickly, thus requiring the use of subcutaneous or intravenous continuous infusion pumps in these tricky moments.
4. The rescue dose can be delivered when the patient requests it, which allows the patient to co-manage their pain.The physician must actively educate, encourage and monitor the patient’s use of rescue doses. A booklet can be used at home to keep track of the rescue doses administered.In hospitals and convalescent homes, a nurse will administer the rescue dose when the patient requests it. Thus, the staff must also be trained in the use of rescue doses.
5. The time between intakes of two rescue doses will be determined and prescribed by the physician.The physician will typically prescribe four hour intervals between rescue doses, which correspond to the activity time of short-acting opioids , to avoid an overdose.An interval of two hours is also acceptable. Intervals of less than two hours are sometimes needed when faced with significant pain episodes.
6. The rescue dose can be given as a preventative measure for induced pain, for example during manipulations, administration of care or transport.In such cases, the preventative administration can be given 30 to 60 minutes before if using oral morphine and 20 minutes before with parenteral morphine.
7. The patient’s pain must be continuously evaluated and the physician must assess analgesic efficiency. If the response to a well-conducted background and rescue dosecombination treatment is poor, the physician must consider different causes such as neuropathic pain, bone pain, infection, inflammation, wound-related pain, and faecal impaction, etc.The impact and weight of the sorrow underneath the pain should not be forgotten.