17 Jun

Morphine is the drug of choice for the management of severe pain in advanced cancer but opioids are frequently denied to patients who could benefit from them.     Patient Opiophobia-Patients and their families may also have fears or express concerns about morphine therapy.     Prescription of morphine is interpreted by some patients as a message that death is imminent.    This requires explanation that morphine can be used for months or years and is entirely compatible with a normal lifestyle.     Other patients resist taking morphine for fear there may be nothing in reserve should their pain worsen. This requires reassurance that the therapeutic range of morphine is sufficient to allow escalation of the dose if necessary.     A history of being ‘allergic to morphine’ usually relates to nausea or vomiting which occurred when parenteral morphine was given to an opioid naive patient for acute pain. Immunological allergy to morphine is rare and given explanation, reassurance and the cover of antiemetics, most patients can be started on morphine without ill effect.     Patients may express concern about addiction. They require explanation about tolerance and physical dependence and reassurance that psychological dependence is not a clinical concern.     If patients claim that morphine did not help their pain it may be that the dose was too low, given too infrequently or they were not given instructions about what to do for breakthrough pain. The importance of other aspects of patients’ suffering — physical, psychological, social, cultural and spiritual — to their perception of pain cannot be underestimated. Patients given morphine in an apparently appropriate dose but who report no benefit, and especially those who report no benefit after escalation of the dose, nearly always have psychosocial problems compounding their pain.• Given adequate explanation, good prescribing and individual titration of dosage, most patients will achieve good pain relief without unacceptable side effects.*53\55\2*

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