MORPHINE AND PAIN MANAGEMENT
What
are the indications for morphine in advanced cancer?
Why use morphine? What about
addiction? Once started, is it ever
possible to discontinue treatment with oral morphine? What is the best way of giving morphine by mouth?
RESPONSE TO MORPHINE
In
relation to pain, when should morphine be used?
Which pains are poorly-responsive to morphine? Which pains are morphine non-responsive?
Can psychological factors really inhibit the action of morphine?
Can I ever be confident that the use of morphine will result in complete
relief?
STARTING TREATMENT WITH MORPHINE
What
are the basic principles governing the use of morphine in advanced cancer?
Is morphine 10mg every 4 hours the right starting dose for a patient
previously receiving an alternative strong opioid?
What is the right starting dose for patients changing from an alternative
strong opioid? Overwhelming pain. How soon should a patient be re-evaluated after starting oral
morphine? How do I work out the
right rescue dose? What other
general advice should a patient be given? How
soon should the patient become pain-free? What
should be done if morphine does not completely relieve the patient’s pain?
If the patient’s pain persists, by how much should the dose of morphine
be increased? Is oral morphine
really effective? How good is
morphine for intermittent (episodic) pain?
COPING WITH UNDESIRABLE EFFECTS
What
are the main undesirable effects of morphine?
Is the use of morphine limited by undesirable effects?
Is an anti-emetic always necessary?
Which anti-emetic is best? Can
the anti-emetic be stopped? Do
patients become drowsy on morphine? Do
some patients go on feeling very drowsy and drugged?
Do patients become confused? Is
postural hypotension a problem? Constipation.
What about sweating? Do
patients die of morphine-induced respiratory depression?
Are there circumstances in which treatment with morphine has to be
abandoned?
MORPHINE BY INJECTION
What
about morphine by injection? [UK
only] Would diamorphine be better than morphine in these circumstances?
Can I use IV morphine for rapid dose titration in a patient in severe
pain? Can I use morphine by
injection if an acute-on-chronic pain crisis occurs?
Wouldn’t injections generally be better?
Once on injections, is it possible to change back successfully to the
oral route? Is it necessary to give
more morphine by mouth than by injection? Can
morphine be given as a suppository? What
about other strong opioids?
MORE QUESTIONS ABOUT MORPHINE
Why do some people need more
morphine than others? What’s so
special about ‘every 4 hours’? For
ordinary morphine tablets and solution, are there any exceptions
to the ‘every 4 hours’ rule? Is
it ever necessary to give morphine more often than every 4 hours?
How can I tell if administration every three hours is
indicated? Should patients be woken
up to take a dose in the middle of the night?
Can a dose in the middle of the night be avoided in other circumstances?
Is a double dose more dangerous? What
about driving? If morphine is
prescribed more than a few weeks before the patient’s death, what happens if
tolerance develops? Don’t
patients die quickly once morphine has been prescribed?
Isn’t the use of morphine tantamount to prescribing a living death? When the patient is close to death and unconscious, can
morphine be stopped? If patients
have morphine at home, won’t it get stolen?
Won’t patients use their morphine to commit suicide?
Is oral morphine the panacea for cancer pain? What are the more important non-drug treatments for pain?
When treating the cancer patient in pain, what else must I bear in mind?
OTHER USES OF MORPHINE
How
is morphine used to relieve breathlessness?
What is the right dose of morphine for breathlessness?
Is oral morphine of value in other forms of terminal illness?
FURTHER READING. INDEX