MYTHS ABOUT MORPHINEMYTH

MYTH: Morphineisapoormedicationfor painwhentakenbymouth.

MYTH: Morphinelowersbreathing function.

MYTH: Morphinetolerance,orthebody’s decreasedresponsetothebenefits ofmorphine,isanimportant probleminpatients.

MYTH: Ifmorphineisprescribedtoosoon duringtheillness,nothingelseis left.

MYTH: Morphineaddictionisan importantprobleminpatientswith chronicillnesses.

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FACTFACT: Morphinetakenbymouthisveryeffectivewhen prescribedandtakenappropriately.Experiencehas shownmorphinetherapytoberesponsiveor workableinmanysituations,reliableandsafe.Itis nowrecognizedthatwhengiveninappropriate amounts,morphinetakenbymouthishighly effectiveinrelievingpain.

FACT: Whilerespiratorydepression(loweredbreathing function)isthemainpossiblehazardofall morphinepreparations,medicallyimportant loweredrespirationsorbreathingrarelyoccursin patientswithpaininwhominitialdosesof morphineareappropriatelychosenandthen increased.(Wecallthisprocessofmonitoringand increasingdosages“titrating,”whichmeanstogive toachieveanacceptablebalanceofpaincontrol withoutunacceptablesideeffects.)Studiesof patientswithadvancedmalignanciesorcancers showednoevidencethatchronicbreathingfailureis eithercommonorsevereinthosereceivinghigh dosesofmorphine.

FACT: Toleranceusuallydoesnotdeveloprapidlywhen morphineisusedforcontrollingcancerandother pain.Someincreaseoccurswithtime,butisusually relativelysmall,andisusuallyduetothedisease worsening.

FACT: Aspainincreases,themorphinedosecanusuallybe adjustedupwardtotreattheincreasedpain.There isnomaximumamountthatcanbegiven.

FACT: Fearsaboutpsychologicaldependence(addiction)are oftenexaggeratedwhenmorphineisusedtotreat severepain.Theabuseofmedicationsmadefrom opiumisrarelyseeninpatientswithcancerorother severepain,nordothesemedicationsleadto addictioninterminallyillpatients.

MYTH: Unacceptablesedation(sleepiness) andmentalclouding(confusion, reducedattentionspan)are frequentsideeffectsofmorphine inpatients.

MYTH: Constipationmakesitimpossible touseadequatedosesofopioid analgesics.

MYTH: Morphineshouldbegivenonan as-neededbasis.

MYTH: Morphinesignifiesthatphysicians have“givenup”onapatientwith aterminalillness.

MYTH: Takingmorphineisakindof “livingdeath.”

MYTH: Morphinecannotbeusedwith othermedicationsforpaincontrol.

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Myths About Morphine

Hospice of the Red River Valley Rev. 0612

FACT: Whencorrectlyprescribedandtaken,morphinedoes notoftenproduceunacceptablementalcloudingor unacceptablesedation.Whilesedationisrelatively common,itisusuallyonlyatemporaryproblemand frequentlyclearswithcontinueduseofmorphine.

FACT: Constipationisacommonsideeffectofmorphine use,andmayoccurinpatientsusingadequatedoses ofmorphineandmorphine-likemedicationsand shouldbetreatedaggressively.Stoolsofteners, laxatives,suppositoriesandenemasareusedto preventconstipation.

FACT: Toavoidpainfromoccurringagainandagain, managementofchronicpainmayrequireusing medicationonaregularlyscheduledbasis.Morphine maybescheduled“aroundtheclock”atregular times,withadosegiveninbetweenthesetimesif painisexperiencedbetweendoses.

FACT: Morphinedoesnothavethismeaningtodayandis notusedonlyforterminalcare.Thereisevidence thatpatientswhosepainisrelieveddobetterthan thosewhoserestandnutritioncontinuestobe disturbedbycontinuedpain.

FACT: Thecorrectuseofmorphineimprovesthequalityof lifeofthepatientwithpainandhelpsthepatient maintainhis/herlevelofselfcareandindependence, mentalawarenessanddignity.Lifeisenhanced becausepainisreducedtoatolerablelevelandthe patientisbetterabletorest,sleepandeat.

FACT: Themajorityofpatientswithchronicseverepain haveacomplexmedicalstatus,andacombination ofmedicationsforpainmaybeused.Thereare specifictreatmentbenefitsgainedfromtheuseof othermedicationstocontrolanxiety,aswell asdifferenttypesofpain.