Case 1

Further history
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Given that Mrs Green’s pain has responded to prn doses of paracetamol, it is likely that 4 hourly paracetamol would control her pain. If 4 hourly paracetamol does not control her pain, then Mrs Green needs to be told to report this to you.

If Mrs Green's pain is not well controlled, initiate an opioid, such as morphine or oxycodone, rather than codeine. Morphine and oxycodone are much more flexible than codeine in terms of dose escalation.

Once the cause of the pain is established, appropriate adjuvant analgesics (eg. corticosteroids) and other modalities (eg. radiotherapy) should be considered.

The bone scan confirms an isolated metastasis in Mrs. Green's right hip.