ABSTRACT
A brief worsening of pain can ‘break through' the analgesia, resulting in distress and the perception of poor pain control, despite good background analgesia with regular analgesics. Since parenteral routes are impractical for long-term use, especially in the community, alternative routes are being used. Movement of the affected part by the examiner will usually result in severe pain on the slightest movement. Local tenderness over a bone suggests a local weakness. Severe skeletal instability can cause pain on minimal movement such as coughing. The pain is distributed in a myotomal pattern, and charts showing the typical distribution of all the main myotomes are available. Spasticity is characterised by an increase in muscle tone due to cerebral or spinal damage involving the upper motor neurones of the corticospinal tracts. Smooth muscle spasm causes regular episodes of pain lasting a few minutes. Troublesome adverse effects can occur within days of starting higher doses, and include diabetes, insomnia or a hyperactive delirium.
