Phys Clinical Cases · oncological
Breakthrough Cancer Pain AND Opioid Titration — DCE Clinical Case
DCE long-case and short-case station for Breakthrough Cancer Pain AND Opioid Titration.
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Breakthrough Cancer Pain AND Opioid Titration — Clinical Case
DCE Long Case
Patient brief
Patient: A middle-aged or older adult with multimorbidity and a presentation centred on Breakthrough Cancer Pain AND Opioid Titration. [1]
Presenting complaint: Subacute or acute symptoms referable to Breakthrough Cancer Pain AND Opioid Titration, with enough detail to force prioritisation. [1] [2]
Past history: Common cardiometabolic and organ comorbidities that interact with the plan. [2]
Medications: A polypharmacy list that includes at least one interaction or dosing issue. [2]
Examination: Key positives and critical negatives for dangerous differentials. [1]
Investigations: A small set of results that change management. [1] [2]
Tasks
- Present a prioritised problem list. [1]
- Defend investigations and immediate therapy. [1] [2]
- Provide safety-net and follow-up advice. [2]
Model discussion points
- Working diagnosis and acuity. [1]
- Differentials and discriminators. [2]
- Treatment sequence and monitoring. [1] [2] [3]
- Multimorbidity and communication. [2]
You have read the opening of this clinical case. The complete unit — every section and its primary-source references — is part of the Physician Medicine fellowship atlas.
References8Show ledgerHide ledger
- [1]Mercadante S, Candido K, Staats P, Davis M Spinal analgesia in cancer pain management-MASCC general practice recommendations Support Care Cancer, 2025.PMID 40634640
- [2]Mercadante S Once again... breakthrough cancer pain: an updated overview J Anesth Analg Crit Care, 2023.PMID 37480136
- [3]Mercadante S An overview of the current drug treatment strategies for moderate to severe, chronic malignant tumor-related pain Expert Opin Pharmacother, 2024.PMID 37016731
- [4]Kiani CS, Hunt RW Lidocaine Continuous Subcutaneous Infusion for Neuropathic Pain in Hospice Patients: Safety and Efficacy J Pain Palliat Care Pharmacother, 2021.PMID 33793373
- [5]Michenot N, Rostaing S, Baron L, Faure S, et al. [Opioid switch and change of route of administration in cancer patients treated by morphine] Bull Cancer, 2018.PMID 30274680
- [6]Xi Y, Yao T, Zhang C, Zhuang T Effectiveness of safety care and clinical nursing pathway in patients undergoing cardiovascular intervention: a randomized controlled trial Perioper Med (Lond), 2026.PMID 42469924
- [7]Marks FJ, Walters SJ, Sutton L, Jacques RM What statistical methods are more appropriate for predicting recruitment at the design stage of a randomised controlled trial? Trials, 2026.PMID 42469922
- [8]Hajiaqaei M, Mohammadi A Transcranial random noise stimulation (tRNS) over the left dorsolateral prefrontal cortex ameliorates emotion dysregulation and executive function: a single-blind, randomized, sham-controlled clinical trial BMC Psychol, 2026.PMID 42469906