Common Misunderstandings about The Use of Morphine for Chronic Pain in Advanced Cancer

Td, Walsh

doi:10.3322/canjclin.35.3.164

Cited by 12 publications

(13 citation statements)

References 8 publications

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“…Sedation and constipation are common, but nausea and respiratory depression are infrequent and temporary [37,38,105,283]. Dry mouth, myoclonus, nightmares, hallucinations, dizziness, pruritus, flushing and sweating are more common than previously thought [37].…”

Section: Side Effectsmentioning

confidence: 99%

“…The preference for morphine is grounded not only in its analgesic efficacy, but also in extensive clinical experience, dose flexibility, and multiple formulations and routes of administration [182,270,282,284]. Concerns about addiction, tolerance, dependence, and respiratory depression, previously exaggerated, have now been put into the correct context [127, 176,282,283,284]. Morphine is a safe, effective medication when used correctly, even in severely debilitated people [182,283].…”

Section: Introductionmentioning

confidence: 99%

“…Concerns about addiction, tolerance, dependence, and respiratory depression, previously exaggerated, have now been put into the correct context [127, 176,282,283,284]. Morphine is a safe, effective medication when used correctly, even in severely debilitated people [182,283]. Pain management in cancer is nevertheless frequently unsatisfactory owing to ignorance about morphine pharmacology, fear of addiction, or side effects.…”

Section: Introductionmentioning

confidence: 99%

“…Analgesics are not restricted to an "as needed" basis, but administered proactively every 4 h around the clock (ATC) [105,201,235,238,276,283]. Oral administration is preferred for its simplicity, convenience and economy [235,270,283].…”

Section: Introductionmentioning

confidence: 99%

“…Oral administration is preferred for its simplicity, convenience and economy [235,270,283]. Morphine has little adverse effect on the health-related quality of life in advanced cancer [140,283].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Morphine in cancer pain management: a practical guide

Donnelly

Davis

Walsh

et al. 2002

Support Care Cancer

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Morphine is the most practical and versatile analgesic for the relief of severe pain associated with advanced cancer. Information is available in the literature about its use in routine clinical practice. Morphine induces analgesia by reducing neurotransmitter release presynaptically and hyperpolarizing dorsal horn neurons at the postsynaptic level, thus preventing rostral transmission of nociception. Morphine has a unique metabolism via glucuronidation (UGT2B7), which results in an active metabolite (morphine-6-glucuronide). The pharmacokinetics of morphine relate to its hydrophilic characteristic, volume of distribution, route of administration and clearance. Renal failure alters its pharmacokinetics more than cirrhosis. The age of the patient and multiple medications will alter morphine pharmacokinetics. Morphine can be given by several different routes: oral, rectal, subcutaneous (s.c.), intravenous (i.v.), epidural and intrathecal. Recent experience confirms benefits of topical morphine for cutaneous pain associated with benign or malignant ulcers. Guidelines for morphine administration are reviewed, and in particular those of the Harry R. Horvitz Center for Palliative Medicine are outlined.

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Section: Side Effectsmentioning

confidence: 99%