Morphine and Unbearable Pain

¶ … Nursing

ISSUES WITH MORPHINE

The importance of the proper management of pain in a patient with a terminal illness cannot be overstated (Broglio, 2008). Pain may not be the most common among the symptoms at the end-of-life stage, but it is what patients and their families fear the most. Unrelieved pain reduces the quality of life and of joy in what remains of that life. It triggers anxiety, depression, loss of hope and the sense of usefulness and worth and also obstructs important decision-making efforts. Family members want the final moments of their departing loved one to as peaceful and comfortable as possible. That is as far as possible from the pain of the approaching end. Pharmacotherapy is still the major approach to the management of pain at this stage of life. Opioids are the main category of painkillers used for such patients because of these painkillers' strength, their accompanying capability to appease fear and calm the patient down. They can also be administered through may routes. Opioids provide sufficient relief from pain in more than ae of terminally ill patients. The most commonly used opioid for terminal illness is morphine (Broglio).

Questions, Answers and Impact of Decisions on Morphine

Opioids are the standard approach to pain management in terminal cases based on pain intensity and the functional and psychological aspect of the severity (Fine, 2007). But misconceptions stand on the way of the effective use of these drugs, which the nurse must be able to answer satisfactorily in order to convince the patient and her son on the appropriateness of their use (Fine).

The first objection to morphine is that it is highly addictive (Fine, 2007). Addiction to painkillers like morphine happens if the severity of the pain is not effectively addressed. Addiction may happen but not usually in terminal cases. It is a bigger concern for doctors if a family member, like the son in this case study, refuses the use of morphine for any reason than for the patient getting addicted to it. Another misconception is the confusion between physical dependence and addiction. Dependence occurs when the body adapts to a drug. Taking it for a long time will make the person dependent on it. Sudden withdrawal will trigger the abstinence syndrome, not addiction. Increased morphine dosage does not mean dependence but the progression of the disease Tolerance is believed to relate to dependence and addiction. More often, doctors suspect disease progression when the usual and effective dose fails. Many patients and their families also suspect that opioids will depress breathing. The fact is that respiratory breathing is rare in terminal cases, as studies have shown. If it happens at all, the clinician can withhold morphine and wait for its effect to fade. Morphine can then be diluted with saline and at intervals to partially reverse the rare effect. Another objection to morphine is its slim therapeutic effect. Quite the opposite, opioids have very broad therapeutic effects. They are the safest and most effective painkillers for both terminal and non-terminal diseases. Only small doses are needed for them to become effective. Still another objection is the ineffectiveness of opioids when taken orally and their nausea side effect. Oral opioids are, in fact, very effective despite being only a third as potent as injected morphine. As to nausea, physicians advise patients to overcome this side effect because no non-opioid painkiller will be as effective as morphine. Moreover, they will develop tolerance to it. They are advised to take anti-nausea medication when receiving morphine. And there is concern substance abusers receiving opiods. They often have terminal illness for which they need opioids. Unfortunately, they are usually tolerant of hese drugs and must consult with pain or addiction specialists or psychiatrists for their specific problem (Fine). #