HealthInfo Waitaha Canterbury
Morphine in palliative care
Morphine is a strong pain relief medicine. Doctors prescribe it when someone has strong pain. This might be after a serious accident or after an operation. It's also used for cancer pain or other serious conditions that simpler pain relievers do not work for.
In palliative care, the time to start using morphine is when your pain is bad enough. It doesn't mean that you're dying.
Morphine only helps some types of pain and you may need to take other pain relief medicines at the same time as morphine. Your doctor will talk with you about this.
You may need to steadily increase the dose of morphine, particularly when starting it, to work out the right dose. Your doctor will do this slowly and steadily over a few days, sometimes taking up to two weeks to find the right dose. As your illness progresses, you may need to increase the dose. But this usually happens because the pain is getting worse. It doesn't mean that the morphine is losing its effect.
When used correctly at the right dose, there is no evidence that morphine either shortens or prolongs life.
Taking morphine
There are two common ways of taking morphine.
Controlled-release (slow-release, long-acting) morphine
This usually comes as tablets that last 12 hours. They come in different strengths from 10 mg through to 200 mg. Your doctor may need to prescribe a combination of tablet strengths to get the right dose for you.
Because they last for 12 hours, you need to take them every 12 hours. For example, at 8 am and 8 pm or at 9 am and 9 pm. These tablets do not help with sudden sharp pain or bouts of pain that happen between the morning and night-time doses.
Immediate-release (fast-acting) morphine
This comes as a liquid or tablets. It also comes in different strengths. It usually starts to work within half an hour of taking it and lasts for up to four hours.
Immediate-release morphine is suitable for sudden pain that happens despite your regular pain relief medicines. This is called "breakthrough pain" or "incident pain".
You can also occasionally use immediate-release morphine before you start taking controlled-release morphine.
Possible side effects
Constipation
Although morphine is a good pain reliever, almost everybody who takes it gets constipated. You should make sure your doctor routinely prescribes a good laxative, which you need to take regularly. You can also help to ease this by eating more fruit, vegetables, brown bread, bran-based breakfast cereals and drinking plenty of liquids.
Nausea and vomiting
About a third of people starting morphine can feel sick or even throw up in the first week to 10 days of treatment. Fortunately, this usually goes away. If this is a problem for you, your doctor can prescribe an anti-sickness tablet. Bear in mind that other things might be causing your nausea and vomiting – it may not be the morphine. Talk to your doctor or nurse if you're having problems.
Drowsiness
Sometimes people feel more sleepy or drowsy than usual for a few days after starting morphine or increasing the dose. This usually wears off quickly. If morphine affects you in this way, you must not drive or operate dangerous machinery.
Less common side effects when taking morphine include unsteadiness, confusion and hallucinations, sweating, blurred vision and a dry mouth.
Morphine addiction
Addiction happens when people who have no pain abuse opioid medicines. When morphine is used to relieve pain, it's very unlikely to cause addiction.
It's sometimes possible to reduce your morphine dose if another treatment can relieve your pain. If you're thinking of reducing your dose, make sure you talk to your doctor about it. Your doctor will reduce your dose gradually to reduce the risk of withdrawal symptoms.
If you need to take higher and higher doses, it may be because your body is getting used to the morphine or because your disease is getting worse. It doesn't mean you're becoming addicted.
Driving
Taking morphine doesn't automatically mean you cannot drive. You need to talk to your doctor about this. But if you have difficulty staying alert or concentrating, or if you're physically weak or ill, it is not wise to drive. If your doctor says driving is OK, follow these general guidelines:
- do not drive in the dark or in bad conditions
- do not drink any alcohol before driving
- do not exhaust yourself by driving long distances
- talk to family and friends about any concerns you have
- do not drive within four hours of taking a dose of immediate-release morphine
- do not drive if you're in severe pain.
Remember – the risk lies with you. If you're involved in an accident, you'll be questioned closely if you seem to be under the influence of drugs.
Alcohol
The combination of morphine and alcohol will probably make you feel sleepy or drunk much sooner than usual. So, it's sensible to drink less than you're used to until you know what effect it has on you.
Recording your morphine use
Keep a diary of the doses and times of any medications you take for any breakthrough pain and any changes to your long-acting morphine. Have this available for your community nurse or GP each time you see them. Also record how often you pass a bowel motion (poo).
HealthInfo recommends the following pages
- Nurse Maude – Managing pain
This leaflet explains how pain relief medication works and what you can do to help manage your pain.
Written by Christchurch Hospital Palliative Care Service. Adapted by HealthInfo clinical advisers. Last reviewed November 2020.
Review key: HIPAL-17434
