Abstract
We have been treating a 70-year-old male patient for chronic noncancer pain (CNCP) in the chest following spine surgery using opioids for 6 years. We started the opioid therapy with codeine and converted it to morphine after 12 months. The morphine dose was increased gradually over 26 months until it reached 200 mg daily. Then we converted to an 8.4 mg fentanyl patch (FP) when it became CNCP-available. His pain was suffi ciently relieved, and his activities of daily living( ADL) were much improved at 12.6 mg. Nevertheless, for safety we decided to decrease the dose to 8.4 mg because we were informed that 12.6 mg might be in the overdose range for CNCP. His pain was exacerbated after the dose was decreased, and ADL remained stable. A maximum dose of 12.6 mg was recommended by subsequent guidelines. In conclusion, when starting the opioid therapy for CNCP we must make management plans that include a maximum dose that has not been announced in cancer pain treatment.
