Morphine and Pain
By Victor Montour
Hospice advocates good pain control for terminally ill patients, even to the point of using narcotic drugs (we call them opiates) such as morphine as they are needed. With all the concern about drug abuse, patients, families and friends sometimes question the use of narcotics. Are we pushing “dope”? Or are we practicing good medicine? I want to explore some of the myths about the use of narcotics for pain control with you
Myth #1: Morphine is offered to patients only when death is imminent.
It is not the stage or phase of a terminal illness, but the degree of pain a patient is having that dictates which medicine to use. We start low with the mildest medicine and if it works, we stop there. If it doesn’t we move slowly onto the next best level of pain control. We move to morphine when it’s appropriate. Some people never need morphine, while others will require it for quite a while. Patients can live for a long time while appropriately taking morphine for pain control. Low and slow is the best way to progress any pain medication.
Myth #2: People who take morphine will become addicted.
Let’s talk a bit about drug addiction. Drug addicts are people who are driven by their need for narcotics; they may commit crimes or harm others to get their needs met. Hospice patients usually don’t have drug-seeking behavior. When a patient’s pain is in good control, they don’t desire more pain medications. Sometimes we can even decrease the dosage. If patients take morphine for a while, their body may become used to it and it should not be suddenly stopped. Stopping the medication abruptly may cause side effects to occur. Side effects of a medication should not be confused with addiction or withdrawal.
Myth #3: People who take morphine will become so sedated (sleepy) that they can’t function.
When patients start to take medications like morphine or other opiates, they often feel drowsy, this drowsiness usually diminishes within a few days and their bodies usually will very quickly build up a resistance to the sedating effects. Most patients whose pain is well controlled on morphine are not bothered by unusual sleepiness. Some people, however, notice a difference in their alertness and might choose somewhat less than perfect pain control as a tradeoff.
Myth #4: People who take morphine die sooner.
Because morphine is used regularly in hospice, patients quickly adjust to any effect that morphine may have. We prescribe a small initial dose, gradually increasing it if needed. In fact; morphine is a drug of choice for breathing distress, commonly referred to as air hunger, in people with end-stage heart and lung disease. It will relax the heart or lungs making the patient more comfortable. This is especially true in patients with lung disease. In the end stage of lung disease the patient is not able to take a deep breath so the inhalers that they may have been using for years are no longer effective.
Myth #5: I’m allergic to morphine: once I had a shot of morphine after an operation and I felt very strange.
Of course you can be allergic to morphine just like any other medicine. But feeling strange is not a sign of morphine allergy usually. Some people may have unpleasant mental sensations temporarily when they start to take morphine. But that is not an allergy; and it might never recur. There are other opiates available for those people who are truly allergic to morphine. To learn more about allergic reactions see our blog post “Speak UP”.
Myth #6: Morphine must be given by injection.
Hospice is a leader in demonstrating the effectiveness of morphine and other opiates taken orally. People who required injections of morphine in the hospital (the most common way of giving morphine there) will probably be able to be well controlled on oral morphine at home. There are also long-acting preparations of morphine which can be given every twelve hours, or opiate skin patches which can be applied every 72 hours, to simplify the routine of pain control.
Myth #7: People should wait until their pain is bad to take morphine so it will be effective when it’s really needed.
There is no upper dose limit to the use of morphine or other opiates. If pain increases we can increase the dose; this is true of very few other medications. Using it when it’s needed early in the course of a terminal illness does not mean that it won’t continue to work later in the disease process.
Morphine, one of the oldest drugs in existence, has found a well-deserved place in the field of hospice whose mission is the relief of pain and other symptoms. We recommend opiates for pain control only if they are needed.
If you would like more information about Front Range Hospice and the use of Morphine, call 303-957-3101 or 970-776-8080 or email us at firstname.lastname@example.org