ORAL MORPHINE IN ADVANCEDCANCER
What are the indications for morphine in advanced cancer?
Why use morphine?
What about other strong opioids?
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 only semi-responsive to morphine?
What do you mean by `morphine-resistant' pains?
Are there any other important morphine-resistant pains?
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 it better to start treatment with morphine solution ordinary tablets or withslow-release tablets?
How do I decide the initial dose of oral morphine?
What about the patient who is taking an alternative strong opioid analgesic?
Is morphine 10mg every four hours the right starting dose for a patient previouslyreceiving 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?
What other general advice should a patient be given?
How soon should the patient become pain-free?
What should be done if the chosen dose of morphine does not completely
relieve the patient's pain?
By how much should the dose of morphine be increased?
COPING WITH ADVERSE EFFECTS
What are the main adverse effects of morphine?
Is the use of morphine limited by adverse effects?
Is an antiemetic always necessary?
Which antiemetic is best?
Are there circumstances in which haloperidol or fluphenazine will not
relieve morphine-induced vomiting?
Can the antiemetic be stopped?
Do patients become drowsy on morphine?
Do some patients go on feeling very drowsy and drugged? ßÿ6 1
Do patients become confused?
Is postural hypotension a problem?
Constipation
Sweating
What about addiction?
Do patients die of morphine-induced respiratory depression?
Are there any circumstances in which treatment with morphine has to be
abandoned?
MORE QUESTIONS ABOUT MORPHINE
Why do some people need more morphine than others?
Is oral morphine really effective?
Is it necessary to give more morphine by mouth than by injection?
Wouldn't injections be better?
What are the indications for injections?
Once on injections, is it possible to change successfully to the oral route?
When close to death and the patient becomes unconscious, should the morphine bediscontinued?
Can morphine be given by suppository?
What's so special about `every four hours'?
For ordinary morphine tablets and solution, are there any exceptions to the `every fourhours' rule?
Is it ever necessary to give morphine more often than every four hours?
How can I tell if administration every three hours is indicated?
Should patients be awakened 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 the Brompton Cocktail?
Is diamorphine (heroin) better than morphine?
What about driving?
If morphine is prescribed more than a few weeks before the patient's death, what happenswhen tolerance develops?
Don't patients die quickly once morphine has been prescribed?
If patients have morphine at home, won't it get stolen?
Won't patients use their morphine to commit suicide?
Isn't the use of morphine tantamount to prescribing a living death?
Is oral morphine the panacea for cancer pain?
What are the more important non-drug treatments?
When treating the cancer patient in pain, what else must I bear in mind?
OTHER IMPORTANT USES OF MORPHINE
How is morphine used to relieve dyspnea (dyspnoea)?
What is the right dose of morphine for dyspnea (dyspnoea)?
Is oral morphine of value in other forms of terminal illness?