• Philip Ang, Hazel Knight, Christina Matadial, Ana Pagan, Rosemarie Curty, Carmen S Nieves, Ana A Acevedo, and Francisca P Dalisay.
• Postanesthesia Care Unit, Miami VA Health Care System, FL 33125, USA. philipkang2000@yahoo.com
• J. Perianesth. Nurs. 2004 Oct 1;19(5):312-30; quiz 331-3.

AbstractThis case study discusses a 64-year-old opioid-tolerant patient who underwent amputation below the left knee and received pain management in the PACU. The patient's self-reported pain level remained 9 on a 0 to 10 scale despite having received a total of 62 mg of morphine sulfate (MSO 4 ) and 60 mg of ketorolac in just less than 3 hours. The patient's facial expression corresponded to a score of 4 to 5 based on the Wong-Baker Faces Pain Scale. This case study illustrates that it is crucial to promptly involve the pain management service when an opioid-tolerant patient requires aggressive pain treatment. The initial patient-controlled analgesia (PCA) order and MSO 4 -loading doses must take into account the patient history of opioid tolerance, increasing the frequency and dosage-loading doses of MSO 4 for treating severe pain until the patient's pain is reduced by at least 50% on a numeric scale, or until the patient states satisfactory relief. The most important rule of pain management is that pain is what the patient says it is.

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