The next few weeks are the worst. Just reading about your husband's struggles remind me of what my husband endured...the remembering makes me feel a little sick. That was 2008 and our lives have improved to a point that I could not imagine then.

Rad team had a formula which I do not now remember regarding breakthrough pain. Depending on the frequency & dose required for breakthrough pain (his was liquid morphine via PEG), Fentanyl was increased by 25 mcg. In the end he was on 125 mcg so your husband's dose sounds low in comparison. The step-down went smoothly by the way.

One horrendous weekend pain, nausea, gagging, etc. all increased at the same time. This was prior to Fentanyl patch. I told MD on call that I didn't think my husband could survive more pain without admission to hospital, which I desperately wanted to avoid. Oncologist nearly doubled both the dose and frequency of morphine for the day! MD checked back with me several times that day - good thing because it was so much morphine that I was scared. By the evening I was able to go back to original dosing and my husband was never in that much pain again. When I explained what had happened to tx room nurses several of them said that sometimes to get the pain in check the cycle has to be broken in this way. Can you talk to cancer team nurses in addition to radiologist/oncologist about this?

Hoping this will be controlled soon.