have found that careful observation over a 24 hour period may suggest larger doses
at times of increased activity. The nighttime dose may be omitted providing a patient can sleep through the night. Because cancer pain is changeable, narcotic requirements will likewise vary. Continuous titration of the dose is necessary so that patients receive neither too much nor too little drug. This together with reevaluation of new pain complaints and appropriate utilization of all available treatment options are necessary if the success described by Twycross and others is to be achieved.When parenteral narcotic administration becomes necessary, the equivalent intramuscular dose of morphine is half the previous oral one.