Open a PDF version to print this topic

HealthInfo Canterbury

Morphine in palliative care

Morphine is made from opium poppies and works as strong pain relief (painkiller). When used correctly in the right sort of dose there's no evidence that it either shortens or prolongs life.

How should I take morphine?

These are two common ways of taking morphine:

Controlled-release (slow-release, long-acting) morphine

This is usually as tablets, which last 12 hours. Examples of these are m-Eslon and LA-Morph. They come in different strengths from 10 mg through to 200 mg.

Because they last for 12 hours, you need to take them every 12 hours, for example at 8 am and 8 pm or 9 am and 9 pm. They don't 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 (elixir) or as tablets (Sevredol). It also comes in different strengths. It generally 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 use it occasionally before you start taking controlled-release morphine.

The name for my slow-release morphine is:

 

The name for my fast-acting morphine is:

 

Does morphine work for all pain?

No. Morphine only helps some types of pain. You may need to take other pain relief medicines at the same time as morphine. Your doctor will talk with you about this

Will I need more and more morphine to control the pain?

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.

What side effects might I get?

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 the vomiting and nausea – 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.

Will I become addicted to morphine?

When morphine is used to relieve pain, it doesn't cause addiction.

If you need to take higher and higher doses, you may worry that you're becoming addicted to morphine. But you may need higher doses because your body is getting used to the morphine, or because your disease is getting worse. It doesn't mean you are becoming addicted.

Addiction happens when people who have no pain abuse opioid medicines. It doesn't happen when your doctor has prescribed the right dose to treat your pain.

What about driving?

Taking morphine doesn't automatically mean you can't drive. You need to talk to your doctor about this. However, if you have difficulty staying alert or concentrating, or if you're physically weak or ill, it isn't wise to drive. If your doctor says driving is OK, follow these general guidelines:

Remember – ultimately 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

Can I drink 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.

Does taking morphine mean I'm near the end?

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, as well as for cancer pain or other serious conditions simpler pain relievers don't work for.

The time to start using morphine is when the pain is bad enough. It doesn't mean that you're dying.

My morphine dose:

Controlled-release morphine (m-Eslon or LA-Morph)

My controlled-release dose is:

 

mg every 12 hours

If you get pain despite taking controlled-release morphine, you can safely take immediate-release morphine every four hours, as you need it. It will work within half to one hour and last up to four hours. If you need more than two doses a day, please consult your doctor.

Immediate-release morphine (Sevredol or Morphine Elixir)

My immediate-release dose is:

 

mg every

 

hours

This dose will change if your controlled-release morphine dose is changed

Who do I contact if I get pain?

My community nurse:

 

My GP:

 

Other contacts:

 

 

 

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. In the diary also keep note of how often you pass a bowel motion (poo).

  HealthInfo recommends the following pages

Written by Christchurch Hospital Palliative Care Service. Adapted by HealthInfo clinical advisers. Last reviewed May 2017. Last reviewed August 2018.

Page reference: 59258

Review key: HIPAL-17434