No Ceiling Dose: Effective Pain Control with Extraordinary Opiate Dosing in Cancer.

A 62-year-old woman with advanced cancer was admitted to the hospital experiencing inadequate pain control. Underdosing of opiates resulted from the persistent and inappropriate labeling of her behavior as drug-seeking, and the medical staff expressed discomfort about the administration of high doses of opiates. Palliative care personnel achieved better symptom control by the use of more confident and more liberal opiate dosing. The patient's quality of life improved immensely without adverse effects. We investigated reasons that account for the widespread practice of opiate underdosing. These include biases such as opiophobia--often unspoken and sometimes unrecognized. We share these insights to enhance the practice of others.