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Morphine

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Updated April 23, 2008

Of all the medications used to treat pain, morphine sulfate is perhaps the most misunderstood and feared. Morphine is commonly used in hospice and palliative care. That's why it’s a common misconception that patients only use morphine when they are at the very end of life.

Why Use It?

In palliative care and hospice, morphine is most often considered the “gold standard” of pain medications. It does a good job of treating pain in most patients and is usually well-tolerated. It’s cost-effective and readily available in most areas. Morphine is also effective in treating dyspnea, or shortness of breath.

What are the Side Effects?

Although morphine is usually tolerated well, it can cause some troublesome, and even serious, side effects. Some side effects include, but aren’t limited to:

  • dizziness
  • lightheadedness
  • drowsiness
  • upset stomach
  • vomiting
  • constipation
  • diarrhea

Be sure to tell your healthcare provider about any side effects. Some of these side effects can be alleviated with treatments, such as an anti-nausea medication for nausea and vomiting, or stool softeners for constipation.

Serious side effects should be reported to your doctor immediately. These may include:

  • slow, shallow, or irregular breathing
  • blue or purple color to the skin
  • fast or slow heartbeat
  • seizures
  • hallucinations (seeing things or hearing voices that do not exist)
  • blurred vision
  • fainting
  • hives
  • rash
  • itching
  • tightness in the throat
  • difficulty swallowing
  • swelling of the arms, hands, feet, ankles, or lower legs

A Thorough List of Side Effects

How Do I Use It?

Morphine comes in several forms, making it the drug of choice in many circumstances.

Oral Morphine Solution:
Oral morphine solution (liquid morphine) is commonly used in palliative care and hospice because it’s so easy to give. It can be concentrated to allow larger doses of morphine to be given in small amounts of liquid. Patients who are unable to swallow pills because of side effects of their illness or decreased level of consciousness can usually tolerate the small amount of liquid needed to make them comfortable.

Oral morphine solution begins working quickly, usually within 15 minutes. It only lasts for 4 hours; however, so some patients may find they have to use it often. Morphine tastes bitter and it’s most noticeable in the liquid form versus pills. Because the concentrated liquid is usually given as such a small amount, it’s not recommended that it is mixed with other liquids. Most patients tolerated taking the medication alone and “chasing” it with the drink of their choice.

Oral morphine solution should be given only with the dosing spoon or dropper that is provided by the pharmacy. Because it is highly concentrated, it’s important to get the dose as accurate as possible. If you are unsure about the right dosing, ask your nurse or healthcare provider to demonstrate for you. I carry a “sample” bottle of morphine with me when I see my patients. The bottle doesn’t contain actual medication but allows me to demonstrate how to use the dropper to draw up the correct dose.

Tablets or Capsules:
Morphine tablets come in rapid release and extended release. The rapid release tablets work similar to oral morphine solution. They work quickly but only last 4 hours. Rapid release tablets can be crushed and put into applesauce or pudding for patients who have difficulty swallowing tablets. It can also be crushed and given through a G-tube.

Extended release (ER or XR) tablets may be taken every 12 hours or even once a day. Extended release morphine is only used in patients who have continuing moderate to severe pain. Always check with your healthcare provider or pharmacist before crushing an ER tablet or opening an ER capsule. Doing so could mean you are delivering a dose that is much too high all at once.

Other Methods of Delivery:
Morphine can be delivered as an injection into the muscle or as an infusion intravenously (IV) or subcutaneously (into fatty tissue under the skin). These forms of delivery aren’t usually the first choice in the palliative care and hospice setting because other delivery methods, like oral morphine solution, are usually quite effective, less painful, and carry less of a risk.

Morphine can also be delivered as a suppository (inserted into the rectum) for patients who need longer-acting dosing but cannot swallow. If this is the form of delivery your doctor feels is right, your physician or nurse should demonstrate how to give it.

If you have concerns about using morphine for pain or shortness of breath, talk with your healthcare provider. They can help find the solution that is right for you.

Sources:

Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002.

Ferrell, BR and Coyle, N; Textbook of Palliative Nursing, Oxford University Press, 2006.

Related Video
How to Choose Pain Medication

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