For a patient with terminal cancer who has severe pain, which analgesic scheduling approach is recommended?

• A. Provide PRN doses of medication whenever the patient requests them
• B. Small analgesic doses to avoid decreasing the respiratory rate
• C. Plan around-the-clock routine administration of analgesics
• D. Sedating the patient to keep them unaware of stimuli

Answer: (C)

The key idea is that severe, persistent cancer pain in a terminal patient is best managed with analgesics given on a around-the-clock schedule to maintain steady, therapeutic levels and prevent painful fluctuations. When pain is treated continuously, the baseline relief is reliable, which reduces distress, improves sleep, functioning, and overall comfort. Relying solely on patient-initiated requests can lead to delays in relief and unpredictable pain control, while giving only small, incremental doses may leave pain undertreated. Sedating the patient to keep them unaware is not an appropriate or ethical default approach; comfort should be achieved with appropriate analgesia and ongoing assessment, reserving sedation for specific refractory symptoms only after careful consideration. In practice, scheduled long-acting analgesics establish consistent control, with short-acting doses available for breakthrough pain as needed, providing both baseline relief and flexible relief for spikes.