Actually that is not the a way it works. They always start Duragesic at 25mg and increase it 25mg at a time. There is a formula for the ratio between the breakthrough pain meds which are "short term, fast acting" opioids vs. the "long term opioids" such as Duragesic. When the intake of short term meds exceeds a certain amount, they will increase the Duragesic. You will still need breakthrough pain medication at times. The Duragesic is supposed to control the overall pain threshold but there will still be breakthrough pain during certain times, such as eating, drinking or some exam procedures.

A 50mg jump is not recommended by the manufacturer according to their warnings, precautions, contraindications and indications for use.

The NCCN pain management guidelines I posted earlier cover all of this in great detail.

At this stage nausea could could caused by a lot of different things. If it can controlled by compazine suppositories you're pretty fortunate. I puked so much in the late and post Tx I polished my teeth like glass from the stomach acid.

Antacids may help as well since chemo does a number on the stomach lining.