Facts about morphine and other opioid medications in Palliative Care
Opioid medicines are pain relievers. They include medicines such as codeine, morphine and pethidine.
Pain is an unpleasant sensation, suffering or distress and it can also make you irritable, make it hard to sleep, reduce your appetite, and make it difficult to be active and enjoy life.
Facts about pain
Not everyone with a terminal illness will experience pain.
Everyone experiences pain differently, so the way you experience pain will be unique to you.
Most pain can be relieved.
Pain is not always constant. It can vary over the day and with different activities. It may also vary with your moods, emotions and family life.
In most cases, working through the following 3 steps in the pain management cycle will relieve your pain. Managing your pain will be a team effort, but the most important person in the team is you.
sharing information – It is important that you openly and honestly share information with your care team so they know exactly what is happening with it. Don’t be tempted to ‘just get by’ so you will be ready for pain medicines ‘later’. Doing so, will reduce your ability to enjoy life now, and may make it harder to relieve your pain in the future.
Involving your carer and family members in the information sharing process can be beneficial because they will often pick up things you have not noticed.
It is important to tell your doctor about all the medicines you are taking, including any over-the-counter, herbal and natural medicines, so they do not unintentionally prescribe a medicine that you are already taking or prescribe a medicine that interacts with your current medicines.
If you have any questions, ask them. There is no such thing as a stupid question: all your questions are good questions. Write down your questions beforehand, and make sure you get the answers you need.
Use a Pain diary to record the details of your pain using words (eg mild, moderate, severe) or numbers (eg 1–10), and record which, when and how much medicine you used. This will help you achieve good pain management by providing an accurate record of your pain and your medicine use. They also make it easier for you and your care team, family and carers to talk about and to understand your pain and the effectiveness of your medicines, particularly when medicines are being changed.
To get a clear picture of your pain, your care team need answers to the following questions.
Where is your pain?
How intense is the pain?
What does the pain feel like? For example, is it sharp, dull, throbbing, aching or what?
When does the pain start and stop?
What makes the pain better or worse?
If using pain medication, how much does the medicine relieve the pain?
• choosing the right medicines – When selecting a medicine or combination of medicines, your doctor will choose the medicines that best match the type, intensity (how strong) and frequency (how often) of your pain.
Sometimes you will have to try several medicines before finding the most effective medicine or combination of medicines. Opioids may also be prescribed for other symptoms, such as dyspnoea (difficult or laboured breathing), diarrhoea or coughing.
Types of pain medication The two main groups of pain medicines are:
mild pain relievers, such as aspirin and paracetamol
medium to strong pain relievers, such as opioid medicines.
All medicines have two names: a generic name and a brand name. Each medicine has only one generic name, but if it is sold by more than one company it will have different brand names.
There are many different opioid medicines, including morphine, pethidine, fentanyl, oxycodone and codeine.
Each differs with respect to the following features:
Length of time before they start working (known as onset of action) and are either immediate or delayed
Length of time they last (known as duration of action) either short-acting (for a short time) or long-acting (for a long time) — some opioids are designed to be released slowly and last for the whole day.
How they are taken (known as mode of administration) either by mouth (tablet, capsule, liquid or spray), by rectum (suppository), by injection into the skin, a vein or a muscle (single injection, drip or syringe driver) or by skin (patch).
Their possible side effects.
You may be prescribed a long-acting, slow release opioid twice a day to provide ongoing pain relief throughout the day. In addition, you may be prescribed a short-acting pain reliever to give you additional pain relief for times when you are more active, such as when bathing.
• Using medicines appropriately. The general rules for using opioid medicines are no different from those for other medicines – take as prescribed
Take your medicines regularly at the times prescribed (or as close as possible to those times) to get the maximum benefit from them. For example, delaying an opioid medicine that takes 2 hours to start working may result in you experiencing pain that could have been avoided.
Organising your medicines and having an adequate supply on hand so you never run out is also essential.
Myths and Facts of Opioid medications. There are many myths about opioid medicines. Knowing the facts will help you use your opioid medicines wisely.
Morphine and other opioid medicines are for improving life — not hastening death. Some people fear that being prescribed opioid medicines means that they’re closer to the end. However, relieving your pain changes your quality of your life — not its length.
The side effects of opioid medicines are manageable. Sometimes people worry that the side effects of their opioid medicines will be worse than their pain. However, not everybody experiences side effects, and most of the side effects are temporary or manageable.
Being aware of the possible side effects will help you cope with them if they occur. Possible side effects of opioid medicines include:
– Constipation — can be relieved by taking laxatives regularly.
– Nausea and vomiting — is often only temporary or can be alleviated with medicines.
– Drowsiness or confusion — may occur for only a short time after starting treatment or increasing the dose.
– Dry mouth — may improve with time.
– Itchy skin — may improve with time
Tell your doctor promptly about any side effects, their severity and when they occur. Your doctor may be able to alleviate them by changing the dose or the medicine.
When your doctor chooses the right dose of opioids for your pain, you will not become addicted. Addiction only occurs when people have no pain and they abuse opioid medicines.
Some people stop taking their pain medicines because they are worried that they will ‘cover up’ the progression of their illness so they won’t know how they’re really going. However, pain medicines will not stop your doctor monitoring the progress of your illness because they have other ways of doing that.
Some people only tell their doctor about their pain when it gets bad. However, it is usually easier to manage pain in its early stages, so the sooner you share information about your pain, the more manageable it is likely to be later.
People often worry that their pain medicines will become less effective. Over time, your body may become used to an opioid medicine. This is called ‘tolerance’. If your medicine is not working as well as it used to, tell your doctor so they can give you good pain relief again by:
• increasing the dose
• prescribing a different medicine
• choosing a different mode of administration
• prescribing a combination of medicines.
Breakthrough pain is pain that occurs while on a pain management plan. It may mean that your opioid medicines have not been taken as prescribed, or it may mean that your doctor needs to review your plan.
Some people worry that using opioid medicines will limit their lifestyle. However, it is the pain, not the medicines, that limit your enjoyment of life. Without pain, you will probably feel better, have more energy, have a better appetite, and be more independent.