We clear up some myths and discuss the 10 things you should know about morphine and its use during end-of-life care.

The approach to end-of-life can be a daunting time for everyone involved. However, many people - patients, their carers and family alike - are often surprised about the valuable and positive role that palliative care can play in improving quality of life and making this time more manageable.

Palliative care assists to improve people’s quality of life during the course of a progressive life-limiting illness. This care isn’t just about pain relief medicine. It is more holistic. It also addresses the psychological and spiritual aspects of care, providing support to help patients live as actively as possible.

Being well-informed about palliative care can make this journey more manageable and help reduce the associated fears and concerns. That is why HammondCare is launching a series of articles to guide people on how palliative care can improve the quality of life for patients, their carers, and families.

10 things you should know about morphine

1. What is morphine?

Morphine is a strong painkilling drug. It has been used for centuries in different forms and works very effectively on many sorts of pain although it is most often used for strong, persistent cancer pain. It can be given in a number of ways. Usually it is first given as a tablet or liquid which works for about four hours. Once you are settled on a regular dose the tablet is often changed to a long-acting version that lasts for 12 hours. It is also given as an injection but this is usually only for people who can’t take a tablet.

2. How do I start taking morphine?

Morphine is started at the lowest possible dose to allow your body to get used to it. Your pain should diminish very quickly (often within hours) but it may take time to balance the right dose for you against the pain that it is being used for. The dose will be increased slowly over days to find what is right for you.

3. Doesn’t morphine have a lot of side effects?

Almost everyone who takes morphine gets constipated. You should have been prescribed a laxative along with your morphine – this should be taken regularly and may need to be increased as the dose of morphine increases.

About a third of people feel a bit sick or actually are sick when starting morphine. This doesn’t mean you are allergic to it (as some people wrongly think). It just means that your body is adjusting to having the drug in your system. Specific medication can be added to reduce this, and stopped once your body has adjusted. It may need to be re-introduced if the morphine dose is increased.

4. If I take morphine, will I get addicted to it?

In the past, morphine was often associated with drug addiction. But taking morphine for pain will not make you an addict. Commonly, people worry when their dose of morphine increases. But the increase is usually because the disease is changing and you need more to manage the pain. Because it is used for persistent pain you should not stop taking morphine suddenly without discussing this with your doctor or nurse.

Some people find they get a bit sleepy with morphine. Once again, this is a sign of your body adjusting to the drug and should ease after a few days. There are other possible side effects – very rarely some people will see things (hallucinations). This may mean the dose is a little high. Occasionally some people will develop an itch.

5. Is there a maximum dose?

No. Morphine is unusual in that there is no maximum dose. If it is taken for pain as prescribed, the dose can be increased gradually to match your pain.

6. What changes do I have to make because I am taking morphine?

Many people find that once they are settled on a stable dose of morphine they can actually do more than they used to because the pain is much less. You shouldn’t have to do anything different. The one exception is driving. You should talk with your doctor about driving. Morphine may slow your reaction time, especially if the dose is increasing from time to time, so be sensible about it and discuss it with your doctor or nurse. The same goes for operating machinery.

7. Will I have to take morphine forever?

You have been given morphine because you have severe persisting pain that is not likely to just stop on its own. However, all your medications, including morphine, will be reviewed regularly by your doctor or nurse. In some circumstances, your pain may resolve because of other treatments you may be given. If this is the case for you then your doctor or nurse can gradually reduce or even stop the morphine. However, if the cause of the pain is still there, most people find they need to carry on taking it.

8. Will I need other painkillers as well? Doesn’t it reduce all pains?

Morphine is very good for some sorts of pain but other pain needs different painkillers. You may need to take several different types of medicine to manage your pain. Morphine belongs to a group of painkillers called opioids. Morphine is the most commonly used opioid, but there are also several others, for example, oxycodone or fentanyl. Sometimes it is necessary to switch from one strong painkiller to another.

Some pain, for example, nerve pain (shooting or stabbing pain), may need a different sort of painkiller to relieve it. Your doctor will be closely monitoring how you are getting on and may need to add in other medication from time to time.

9. I’ve heard that morphine is sometimes used for breathlessness?

There are many reasons for people to be breathless but from time to time the best drug to use for this symptom is morphine. It reduces the feeling of breathlessness that you have without removing the real cause. It ‘masks’ the cause and helps you to feel better and more relaxed.

10. Does taking morphine mean I am near the end?

Many people think that morphine is only given near the end of life; this is not true. You are given morphine to relieve strong pain. Your doctor will explain the reason s/he is prescribing morphine. If you have any doubts at all then just ask. Don’t spend days worrying. If there is anything at all you don’t understand, your doctor or nurse will be only too pleased to help.

If you have benefited from this information and would like to share it with others, then please do – we want more people to feel comfortable facing the issue of palliative care.