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Morphine in palliative care

Rongoā morphine ki te manaakitanga whakamaene

Important

Take your medication as directed. Contact your community nurse or other health professional if your pain is not controlled or if you or your whānau have any concerns.

If you are unable to contact your regular health professional and have serious concerns, call 111.

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 is also used for cancer pain or other serious conditions simple pain relievers are not enough.

In palliative care, the time to start using morphine is when your pain is bad enough. It does not mean that you are dying.

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.

You may need to steadily increase the dose of morphine to work out the right dose. Your doctor will do this slowly and steadily over a few days, sometimes taking up to 2 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 does not 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 100 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 4 hours. It is often used as the initial treatment for pain, before controlled-release morphine is prescribed.

Immediate-release morphine is suitable for sudden pain that happens despite your regular pain relief medicines. This is called "breakthrough pain" or "incident pain".

Incident pain is where you get pain from certain activities such as taking a shower, going for a car drive or spending time in the garden. In these situations, you can also use immediate-release morphine before you start that activity.

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 and bran-based breakfast cereals. And by 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. Your doctor will prescribe an anti-sickness tablet. You can take this regularly to prevent nausea or just as needed. 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 are 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. Also, sweating, blurred vision and a dry mouth.

Morphine addiction

Addiction can happen when people take opioid medicine for a long time or if they abuse opioid medicines.

It is sometimes possible to reduce your morphine dose if another treatment can relieve your pain. If you are 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 does not mean you are becoming addicted.

Driving

Taking morphine does not 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 are 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 4 hours of taking a dose of immediate-release morphine
do not drive if you are in severe pain.

Remember – the risk lies with you. If you are involved in an accident, you will 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 is sensible to drink less than you are 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 general practice team each time you see them. Also record how often you pass a bowel motion (poo).

Written by Christchurch Hospital Palliative Care Service. Adapted by HealthInfo clinical advisers. Last reviewed October 2024.

Sources

The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public

Canterbury Community HealthPathways – Cough in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Dyspnoea in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Pruritus (itch) in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Weakness and fatigue in palliative care, retrieved December 2016.

Canterbury DHB – Palliative care guidelines (http://cdhb.palliativecare.org.nz/4207.htm), retrieved August 2016.

Nurse Maude – Symptom management (https://www.nursemaude.org.nz/wp-content/uploads/2023/02/Symptom-Management-2020-LR.pdf), retrieved December 2016.

Palliative Care Australia – Facts about morphine and other opioid medicines in palliative care, retrieved February 2017.

Palliative Care Australia – Learn more about pain and pain management, retrieved February 2017.

South Island Alliance – Health of older people useful resources (https://www.sialliance.health.nz/programmes/health-of-older-people/useful-resources/), retrieved September 2022.

UpToDate – Managing pain when you have cancer, retrieved February 2017.

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Review key: HIPAL-17434