Myths of Morphine

Being in pain is a common fear of those with a terminal illness. Relieving pain and symptoms is a top priority with hospice care, so special attention is given to alleviate pain. Many myths are associated with the use of morphine. These misconceptions should not stand in the way of an individual receiving relief:

Myth Fact
Myth: Morphine is a poor medication for pain or shortness of breath when taken by mouth. Fact: Morphine taken by mouth is very effective when prescribed and taken appropriately. It’s now recognized that when given in appropriate amounts, morphine taken by mouth is highly effective, reliable and safe in relieving pain and shortness of breath.
Myth: Morphine lowers breathing function. Fact: While lowered breathing function is a possible concern of using morphine, it’s recognized as a safe and reliable way to help bring your breathing back to a normal level when you’re experiencing pain. When you experience a high level of pain, your breathing function is strained and often too high. By using appropriate doses of morphine, it can help bring your breathing function back to a normal level. Studies of patients with advanced malignancies or cancers showed no evidence that chronic breathing failure is either common or severe in those receiving high doses of morphine.
Myth: Morphine tolerance, or the body’s decreased response to the benefits of morphine, is a problem in patients. Fact: Tolerance usually does not develop rapidly when morphine is used for controlling cancer and other pain. Some increase occurs with time, but is usually relatively small, and is usually because of the disease worsening.
Myth: If morphine is prescribed too soon during the illness, nothing else is left. Fact: As pain increases, the morphine dose can usually be adjusted upward to treat the increased pain. There is no maximum amount that can be given.
Myth: Morphine addiction is a problem in patients with chronic illnesses. Fact: Fears about addiction are often exaggerated when morphine is used to treat severe pain. The abuse of medication made from opium is rarely seen in patients with cancer or other severe pain, nor do these medications lead to addiction in terminally ill patients.
Myth: Unacceptable sedation (sleepiness) and mental clouding (confusion, reduced attention span) are frequent side effects of morphine in patients. Fact: When correctly prescribed and taken, morphine does not often produce unacceptable mental clouding or unacceptable sedation. While sedation is relatively common, it’s usually only a temporary problem and frequently clears with continued use of morphine.
Myth: Constipation makes it impossible to use adequate doses of opioids. Fact: Constipation is a common side effect of morphine use and may occur in patients using adequate doses of morphine and morphine-like medications. It should be treated aggressively. Stool softeners, laxatives, suppositories and enemas are used to prevent constipation.
Myth: Morphine should be given on an as-needed basis. Fact: To avoid recurring pain, managing chronic pain may require using medication on a regularly scheduled basis. Morphine may be scheduled “around the clock” at regular times, with a dose given in between these times if pain is experienced between doses.
Myth: Morphine signifies that physicians have “given up” on a patient with a terminal illness. Fact: Morphine does not have this meaning today and is not used only for terminal care. There is evidence that patients whose pain is relieved do better than those whose rest and nutrition continues to be disturbed by continued pain.
Myth: Taking morphine is a kind of “living death.” Fact: The correct use of morphine improves the quality of life of the patient with pain and helps the patient maintain his/her level of self-care and independence, mental awareness and dignity. Life can be enhanced for the patient because pain is reduced to a tolerable level and the patient is better able to maintain comfort.
Myth: Morphine cannot be used with other medications for pain control. Fact: The majority of patients with chronic severe pain have a complex medical status, and a combination of medications for pain may be used. There are specific treatment benefits gained from the use of other medications to control anxiety, as well as different types of pain.

If you have questions about the use of morphine as a pain medication for your loved one, please contact a member of your hospice care team.