Frequently asked questions
Janet Dunphy, Mary Kiely in Communication in Palliative Care, 2020
Addiction does not occur when morphine is used for pain control; the problem does not apply to palliative care patients. It’s important to be clear about that. Also that syringe drivers are used in the dying phase because the patient is dying. This may have to be stated explicitly. We are using a syringe driver because dad is dying and can’t swallow his medicines any more. He will not die quicker because of the syringe driver, he will simply die more peacefully. It can seem that someone dies because a syringe driver is started; in fact, they were dying before it was used. It’s the best way to support him and to keep him comfortable. Is there something you would like to ask me?How will I know he is dying?You will see the changes. He will stay in bed more and eat and drink less. Often people slip into unconsciousness at the end, in a peaceful way. You will notice the changes in the breathing during the final phase. Don’t worry, the doctors and nurses around you will see the changes and advise you all the way through.What will happen? Will I be in pain or just go to sleep?
Liposome-Based Nanocarrier System for Phytoconstituents
Madhu Gupta, Durgesh Nandini Chauhan, Vikas Sharma, Nagendra Singh Chauhan in Novel Drug Delivery Systems for Phytoconstituents, 2020
Morphine is a naturally occurred alkaloid of the opium poppy Papaver somniferum that is particularly useful in medicine, both as an analgesic and anesthetic (Kirby, 1967). Especially in cancer therapy, morphine has been a commonly used pain reliever. Since pain is a typical complaint for many cancer patients, it is often managed by a fixed schedule opioid regimen, including morphine (Paul et al., 2001). Moreover, opioids are also utilized in clinical practice for postoperative pain treatment. Left ineffectively managed, postoperative pain can result in poor clinical outcomes and/or adverse events, such as deep vein thrombosis, myocardial infarction, and coronary ischemia. Epidural morphine sulfate has more advantages than intramuscular morphine in terms of smaller doses, analgesic efficacy, and recovery process. However, the pain relief effect of a single epidural morphine injection only lasts <24 h, while other techniques to prolong the analgesia can be costly, risky, and inconvenient.
The legal framework for palliative care in the Netherlands
John Lombard in Law, Palliative Care and Dying, 2018
Hasselaar et al. highlighted a significant increase in the use of benzodiazepines for sedation rather than use of morphine.153 This is in line with recommendations contained in the Guideline.154 The reason for favouring benzodiazepines as a sedative is due to the ‘unpredictable sedative and side effects’155 of morphine. A high use of midazolam for sedation, 73.6%, was also reported by the respondents in Brinkkemper et al.156 Yet, it was also highlighted that in 13% of cases there were problems in the use of medication. This included delirium, agitation, and problems such as toxicosis due to morphine use. The availability of appropriate palliative medicines was also a concern raised by Brinkkemper et al. In 17.2% of cases palliative medications were not always available. This may be due to timing such as out of hours access at night time or during weekends.157 The study by Arevalo et al. also underlined this shortcoming in home care. Although respondents reported that medications were available in 94.94% of cases and medical equipment was accessible in 93.90% the figures for home care settings were much lower, 83.67% and 87.75% respectively.158 This is an issue which is beyond the scope of a Guideline alone and raises human rights issues such as those discussed in Chapter 3. It requires action at an institutional level if an effective remedy is to identified and implemented.
Chronic Pain: A Case Application of a Novel Framework to Guide Interprofessional Assessment and Intervention in Primary Care
Published in Canadian Journal of Pain, 2023
Jay Reaume
The author’s assessment involved gathering the patient’s history and completing a medication review. The patient’s morphine equivalent dose (MED) was calculated at 82.5 mg of morphine daily, just below the maximum dose of 90 mg daily recommended by the Canadian “Guideline for opioid therapy and chronic noncancer pain.”7 The Opioid Risk Tool was completed and the patient scored a 7, indicating moderate risk of opioid abuse.8 The patient was also asked to complete several PROMs during this assessment,9–15 the results of which were used as data in applying Walton and Elliott’s framework.6 They included the Brief Pain Inventory Short Form (BPI-SF),9 which measures pain severity and impact on function; the Brief Illness Perception Questionnaire (BIPQ),10 which assesses the emotional and cognitive representations of illness; the Pain Catastrophizing Scale (PCS),11 which assesses pain-related catastrophic thinking; and the Depression, Anxiety, and Stress Scale (DASS21),12 which measures levels of depression, anxiety, and stress. Additional PROMs included the Central Sensitization Inventory (CSI),13 which measures symptoms commonly associated with central nervous system hypersensitivity; the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS),14 which is used to identify neuropathic pain symptoms; and the Tampa Scale for Kinesiophobia (TSK),15 which measures fear of movement and reinjury. Once they were completed by the patient, they were reviewed and scored by the author.
The effects of morphine on vascular cell adhesion molecule 1(VCAM-1) concentration in lung cancer cells
Published in Archives of Physiology and Biochemistry, 2023
Ahmad Ghasemi, Golnaz Vaseghi, Alaei Hojjatallah, Shaghayegh Haghjooy Javanmard
For several years, morphine has been used to induce analgesia and relieve pain in patients with cancer (Maher et al. 2020). It has been shown that morphine not only acts through opioid receptors (McDonald and Lambert 2015)but also it can activate other pathways (Vaseghi et al. 2012) such as TLR4 (Haghjooy-Javanmard et al. 2018, Maher et al. 2020). Despite extensive research, it is still not clear how morphine affects the cancer cells. Some studies have shown that morphine can increase tumour growth and decrease survival rates (Niu et al. 2015), but others have demonstrated that morphine may prevent cancer growth and metastasis (Gach et al. 2011). It seems that morphine also plays a dual role in the regulation of tumour metastasis. However, the mechanisms remain uncertain.
The potential interplay between opioid and the toll-like receptor 4 (TLR-4)
Published in Immunopharmacology and Immunotoxicology, 2023
Nasrin Zare, Marjan Pourhadi, Golnaz Vaseghi, Shaghayegh Haghjooy Javanmard
Signaling pathways of RAS/MAPK (mitogen-activated protein kinases) and NF-κB are involved in cancer progressions [58]. TLR-4 signaling can lead to inflammation and apoptosis, and the proliferation of some tumor cell lines also can contribute to metastasis [59–61]. TLR-4 activation on the immune cell is needed for the immune response against dying tumor cells and potentiates the efficacy of antitumor therapy in the tumor microenvironment [62]. Opioids can induce activation of the μ-opioid receptor and TLR-4 on cancer cells and tumor-associated cells [63,64]. Opioids are used to manage the perioperative period and excruciating pain in patients with cancer. Although the role of opioids is well-known in the central nervous system (CNS), there are concerns about the use of morphine in cancer patients. In vitro studies have shown that opioids treatment results in proliferation, migration, and invasion of tumor cells. Also, morphine pretreatment at some doses before radiation may decrease the efficacy of radiation in breast and cervical cancer cells. Some of these effects might be TLR-4 dependent, not opioid receptors. Modulation of TLR-4 activation by opioids can have unknown effects on tumor growth and metastasis and it is very likely context-dependent [65–67].
Related Knowledge Centers
- Intramuscular Injection
- Opium
- Papaver Somniferum
- Rectal Administration
- Sublingual Administration
- Transdermal
- Spinal Cord
- Opiate
- Analgesic
- Subcutaneous Administration