Managing pain is a major part of the role of hospice teams for end-of-life care. From aspirin to opiates, each patient’s pain levels must be addressed on an individual basis. Yet in a culture where concern about prescription drug addiction and abuse, loved ones of the terminally ill can become concerned about the use of known addictive substances to manage pain. The information provided below is for the purpose of addressing and correcting the most common myths about the medications chosen to relieve pain during end-of-life.
MYTH – Morphine will only be offered to patients who are imminently terminal.
Hospice teams address the presence of pain by evaluating level, not estimated time left. If morphine is the medication required to ease pain, then morphine will be recommended. Some patients may never experience pain at the level when a powerful drug like morphine is needed, while other patients may live with severe pain for quite some time, relying on morphine for quality of life during the time they have remaining.
MYTH – Morphine causes addiction when taken for some time.
The definition of a “drug addict” is quite different than the definition of a hospice patient who is living with persistent, chronic pain. For addicts, acquiring and taking the drug is desirable as an end in itself. For hospice patients living with chronic pain, taking a drug is only desirable if it will provide relief from the pain. While it is important for hospice patients taking strong medications like morphine not to stop it all at once due to side effects, gradual tapering can mitigate these if pain begins to ease and the drug is no longer needed.
MYTH – Morphine puts hospice patients into a somnolent (perpetually sleepy) state.
Like many drugs, morphine can initially cause some degree of drowsiness. But the human body soon learns how to compensate for this effect, which is why it is regarded as temporary. For hospice patients taking morphine for reasons of pain control, most do not report excessive sleepiness as an ongoing side effect. For those who do feel a little drowsier than normal on an ongoing basis, most state that the relief from pain provided is a more than worthwhile tradeoff.
MYTH – Morphine accelerates death because it can cause a patient to stop breathing.
Morphine has been in use as a drug for pain management for a long time now and the potential side effects are very well understood. For this reason, patients are never prescribed a large initial dose – rather, they take a small dose initially and build up to the amount they need to effectively manage their pain. This prevents issues like breathing cessation from occurring. In fact, for hospice patients who are suffering from terminal heart or lung disease, morphine is a medication of choice to ease breathing discomfort.
MYTH – Morphine makes me feel strange so I must be allergic.
Morphine allergies are possible just like allergies to any drug are possible. However, feeling strange or mentally out of sorts is not considered an allergy. For any hospice patient with a true history of morphine allergies, there are other opiate options available to manage pain.
MYTH – Morphine is an injectable drug only.
Morphine can be taken orally and via skin patches as well as via injection. The delivery method is chosen based on the level of pain, but all are equally effective at getting the drug into the patient’s system.
MYTH – Morphine should only be taken for severe pain or it will lose its effectiveness.
Morphine is one of the few opiates that can be decreased or increased as needed with no loss in effectiveness. This means it can be prescribed at any time for pain management. Morphine is one of the most well established medications in use today for relief of pain at all stages of life. The type of pain medication given to hospice patients will always be based on their personal medical history, preferences, pain type and severity. Today’s hospice teams have many options available for successfully easing pain in end-of-life patients, of which morphine is only one.
