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!

Opioids for CANCER pain

In my previous post I have talked about “PAIN” relief in cancer. In this post, I will be talking about about opioids- drugs which are used to provide some relief from the constant "difficult" pain.

With each passing day, cancer becoming more aggressive, pain becomes a 'constant' part of life. The pain is not only acute but is chronic and with time, it tends to become more uncontrollable. At this stage doctors prescribe OPIOIDS.

What are opioids?

Opioids are medicines that are used to provide relief from moderate to  severe pain( usually in cancer) .These medicines work on the principle of "reducing the intensity" of the pain signals being sent to the brain and affect those areas controlling these senses, and thereby considerably minimising the effects of the painful signals.

Opioids act much like endorphins-  natural substances created by the body to restrict or limit pain. Some of them work better than others in terms of providing  relief from terrible pain. 

Opioids were once formulated from the opium poppy( plant), but today many pharmaceutical companies are creating these drugs synthetically in laboratory, though addiction to these drugs still remains a critical issue .

Types of Opioids

Severe Pain

• Morphine 
• Buprenorphine
• Fentanyl and Alfentanil  
• Hydromorphone 
• Diamorphine
• Methadone
• Oxycodone 

Moderate to mild pain 

• Tramadol
• Codeine 

All  of the above mentioned drugs are available at drugs store strictly on prescription. 

Side effects

Most of the people taking these drugs over a period of time develop a kind of tolerance to these drugs. Therefore, the doctor has to prescribe higher dosage to provide relief from pain  or the other reason can be  increase in pain due to the advancement of the disease. 

A little  increases in the dosage or a change in the type of medicine will help in relieving the pain.

Common Side-effects

• Hallucinations
• Confusion
• Vivid dreams 
• Myoclonic jerks.
• Sedation
• Nausea and vomiting 
• Constipation
• Dry mouth 
• Itchy Skin 
• Coughing,wheezing, and shortness of breath
• Difficulty in passing urine
• Blurred vision

All these symptoms are common, and usually the treating doctors provide medicine to help overcome these effects. 

Im my personal view these symptoms never actually go away. Though the doctor’s do prescribe some medications to control these symptoms, but they prove to be of little or no help. Eventually all the symptoms emerge. ( In case of my father, where I tried my level best to read about the symptoms before hand, so that I could "prevent" them from emerging. With absolutely no result, my father went away!)

Towards the end, when pain becomes “difficult", the body has become resistant to opioids and nothing helps- the focus should be on making life easy- good palliative care.

Because you love them, tell them, show them- be with them. They need you, for the last time!

I love you papa!

Cancer- Dealing with pain

As CANCER advances, pain only increases. Treatment is almost over. Nothing much can be done now medically, only efforts to reduce the pain can be done ( Palliative Care).  Around 2/3 of the patients suffering from cancer experience acute pain. The pain is almost unbearable for the patient and is equally painful for you to see your loved one in pain. 

For treating pain, Doctors use all sorts of medicines - from simple drugs like Paracetamol (Analgesics) to Morphine (Opioids). Honestly nothing helps, but if the medicines are given timely  and in proper dosage, then they are of some help. The patient do experience some relief, if the pain has been analyzed properly and timely.

A study conducted by doctors in UK, says that Tolerance to pain can be Increased in the following ways

• Rest 
• Diversion
• Physiotherapy 
• Relaxation therapy
• Empathy 
• Support from family
• Listening to Music
• Expressing emotionally

Tolerance to pain is reduced by

• Anxiety
• Sadness
• Introvert Attitude
• Insomnia
• Socially Cut-off
• Fear
• Fatigue
• Anger
• Mental Separation
• Depression

Pain can be described as physical expression of social, spiritual and psychological isolation. To feel pain, one need not suffer. Dealing with pain, a lot of effort is required that too in a very organized and a sensitive way.

• Proper Medication
• Counseling
• Other Therapies
• Spiritual Support

Apart from all  of the mentioned above, support from family plays a pivotal role in making life easy for your loved ones. Talk to them, make them express, listen to them-After all you love them and this is the least you can do for them.

I love you Papa!