What is considered a ‘high’ dose on a syringe driver?

[OvertiredAndUnderwhelmed]

I’m just wondering if anyone medical or with experience of this could answer my question? My mother has pancreatic cancer and has been moved onto a syringe driver. She is still however in pain and the nurses are increasing the dose into it nearly every day. I’m just wondering what is ‘normal’ so to speak and what is indicative of the end being imminent so that we can prepare as best you can. Thank you.

Please just ask for more pain relief for your mum- she should be able to get extra pain relief across the day and that helps recalibrate the dose in her syringe driver… so don’t wait for an increase.
in terms of what’s high- that’s not really something that is necessarily related to when they will pass

Pain is very personal and the nurses will be trying their best to make your mom comfortable at this difficult time. They may be increasing it until they find what works and it has to be done gradually and safely following procedure, they can't just whack your mum on a high dose straightaway. Don't worry about the dosages, it's not indicative of when your mum will pass. Sending ❤️

Sorry I probably didn’t explain very well - they are increasing her driver based on the morphine injections they are administering on top throughout the day. Mum is very well cared for and her pain is taken seriously and responded to. I’m just curious about the dosage as I don’t want it to become an issue e.g we cannot give a higher dose through the syringe driver than x amount etc.

Yup that all sounds very normal. The amount of breakthrough your mum gets throughout the day dictates how much goes into her syringe driver. They will want to keep her pain at bay and reduce the need for top ups. It won't be an issue OP don't stress, and there are plenty of other alternatives if for some reason she cannot take morphine anymore.

As long as your Mum is kept comfortable and not distressed please don’t worry about the dose . From my experience it depends on the meds in the SD and how the patient responds to pain. Just hold your Mums hand and be thankful that she is peaceful.Pancreatic cancer is horrific and the priority is for her comfort and dignity.
Ther will also be prn medication that the nurses can give to top up if necessary. Hopefully the hospice staff are involved to ensure your Mums comfort and reviewed daily. X

I wonder if it may be more about the pace than the dose?

I've heard from someone in a palliative care team to think that if you're seeing monthly deterioration they have months, if you're seeing weekly deterioration they have weeks and if you're seeing daily deterioration they have days. But even that won't always be right - people can have setbacks and improve again etc.

I hope you are doing ok x

There is no limit in palliative care, she needs what she needs. Xx

It's all very normal. The extra morphine is for break through pain. If your mum is needing this more often then they will calibrate the syringe driver to deliver the 'extra' doses through that instead. Pain relief can be based on an individual's need rather than a set dose. It sounds like the nurses are excellent and very experienced. Sending

They may change the morphine to fentanyl if it's not working well enough. This was done for my Dad on his last day. Sometimes it's better to give a smaller dose of a stronger drug, rather than a really high dose of a weaker one.

Agree there is no real limit for syringe drivers. We have patients that require 2 drivers to deliver the right quantites of analgesia. Everyone is different so there are no hard and fast rules

💐for you and your mother

Thanks all - as an update she is currently on 90mg of morphine in her driver and having injections as and when she needs them still. She has deteriorated quite a lot since my original post in terms of her mobility / appetite etc but still mostly is quite sharp and knows what’s going on. It’s just so hard to predict how she’ll be from one day to the next!