A 25 y/o patient was admitted to our hospital for last 2 weeks with newly diagnosed lymphoma. He is being treated with combination chemotherapy. Ten days after the start of chemotherapy he developed severe pain on swallowing Upon examination, by upper GI endoscopy herpes, simplex esophagitis was diagnosed. He is unable to eat solid foods due to the pain although he can swallow some liquids.
The pain is described as "really bad" and is not relieved by acetaminophen with acetaminophen with codeine phosphate ordered q4h prn. The patient repeatedly asks for something for pain prior to the 4-hour dosing interval and is often reported moaning. The attending physician is concerned about using an opioid of greater potency or administering opioids more frequently because the patient admitted to a history of poly-drug abuse, although none in the last two years. Although we have recommended MSIR…
