Mark has been using 30mg oral morphine every 4 hours but he has complained to you about the side effects of morphine.

In an effort to resolve his difficulties you have suggested using a Durogesic DTrans patch instead and have prescribed him a 50mcg per hour patch (conversion tools).

Within 24 hours of applying the patch Mark begins to feel agitated, sweaty, develops goose pimples, and has abdominal cramps and diarrhoea.

His pain relief is now worse than when on morphine..

If he takes morphine breakthrough medication his symptoms settle for a few hours but then recur.

Explanation: Lack of cross tolerance between morphine and fentanyl in this case has led to morphine withdrawal symptoms

(References)

Action –

Recommend that Mark takes his normal release morphine to relieve any withdrawal symptoms. This will settle within 2 or 3 days.

Titrate up in patch strength no more often than every 72 hours, using immediate release strong opioids for breakthrough pain, until Mark's pain is controlled.

Conclusion

Mark's morphine has been stopped and he has been commenced on a Durogesic DTrans patch. Despite uninterrupted continuation of a different opioid in this case fentanyl, a small number of patients experience withdrawal from their previous opioid, in this case morphine.