Occasionally, children require very high doses of opioid to control pain. This may occur for several reasons. The child on long – term opioid pain management can become tolerant of the drug, meaning that it is necessary to give more drugs to maintain the same level of pain relief. This should not be confused with addiction, which is a psychologic dependence on the side effect of opioids. Addiction is not a factor in managing terminal pain in children. Other obvious reasons for requiring increased doses of opioids include progression for requiring increased doses of opioids include progression of disease and other physiologic experiences of pain. It is important to understand that there is no maximum dose that can be given to control pain. However, nurses often express