Morphine in palliative care

The best way to treat pain is assessing the pain. Knowing the root cause of the pain will help the doctor to prescribe the best type of medication.The medication can rage from a combination of different pain killers and their dosages.

Generally morphine is given to patients, when end is mostly obvious and there is no hope. For most of the patients- who are given morphine, It is generally not the stage of the cancer, but the degree of the pain endured by the patient.  The pain is constant and continuous.

Assessing Pain

To treat the pain, It is extremely important that it is analyzed properly with careful observation. The best way to assess the pain is to get the patient to talk, be involved in the treatment. Apart from this the family of the patient can monitor the patient( at least once a day) taking into consideration the following factors. 

• Physical effects 
• Practical Impact
• Emotional factors. 
• Spiritual needs

Route(s) to administer Morphine

• Oral 
• Rectal
• Sublingual
• Subcutaneous
• Intramuscular
• Intravenous. 
• Transdermal (The most common used nowadays)

Towards the end, pain becomes stubborn and responds poorly to opioids. No drugs or most of the drugs fail to provide relief from pain. However, morphine- one of the oldest drug is still used extensively in palliative care for the patients with fast approaching end.

Intolerance to Morphine

The patient tolerance to morphine can be attributed to the following factors

• Exposure to opioids in the past. 
• Hereditary
• Opioids providing no relief
• Rate of dose titration. 
• Additional treatment being given. 
• Disease related 
• Kidney and liver function.

The best way to improve  morphine intolerance is to start with a low initial dosage and gradually titrate upwards. Despite of best efforts, if things don’t change then consider substituting the opioid. 

If the condition still persist, try changing the route in which the opioid is administered. If still there is no change in the condition, then probably the pain was not assessed properly, look for other causes of pain. Besides, it is important to manage the side effects with additional medication.

I love you, Papa!