Morphine Myths

By: Jillian Lisiakowski, DNP, FNP-C, ACHPN

Morphine is a common opioid medication used to treat pain and symptoms for many different diagnoses. Morphine and other opioid medications are often used to treat pain related to injury, surgical procedures, shortness of breath, cancer, and other pain experienced at the end of life. Many patients, however, suffer from uncontrolled pain at the end of their lives due to the fear of causing respiratory depression and early death. This fear is commonly shared by nurses, providers, family members, and patients. While morphine is not the only option available, it is a safe and effective option to consider when prescribed by medical professionals trained in pain management.

Studies show that pain is present in 30-75% of patients in the last days of life¹. Pain can be caused by physical conditions as well as social, spiritual, and psychological distress³. Fear of uncontrolled pain is common in patients at the end of their life and is a common reason for emergency room admissions^4,5. The goal of many patients and families at the end of life is to remain comfortable while being surrounded by their loved ones in their own homes. Well-controlled symptoms such as pain and shortness of breath can make this wish a reality and can reduce the need for unnecessary emergency room visits and hospital admissions.

Many people are cautious of prescribing or taking opioids while in hospice care due to the fear of causing respiratory depression or early death. Several studies, however, suggest that respiratory depression typically does not occur except in experimental situations or cases with a sudden and significant increase in the dosage of morphine. There is little evidence to support an earlier death or risk of respiratory depression when morphine is titrated, or increased, slowly based on the patient’s level of pain⁷. There is also evidence to support that when morphine is prescribed correctly, even in higher doses, the number of survival days increases as compared to patients with lower morphine doses². This increased pain control gives patients a better quality of life while being able to remain in their homes with their caregivers and loved ones.

Morphine is also commonly used to treat symptoms such as dyspnea in chronic conditions such as COPD and cancer and during end-of-life care. Dyspnea is defined as breathing discomfort, often described as air hunger, chest tightness, or a feeling of suffication³. The dosage of morphine is usually lower when used to treat shortness of breath alone. This works by reducing anxiety levels and slowing the respiratory rate enough for complete exhalation to occur⁵. This improves the breathing cycle, allowing for more effective inhalation and increased oxygenation. Medications such as bronchodilators and oxygen can be more effective when the patient can take more complete breaths.

It is important to discuss your wishes, or your loved ones’ wishes, regarding pain and symptom control with family and healthcare providers to ensure the desired plan of care is created. Having these discussions early can alleviate the fear of uncontrolled pain and symptoms at the end of life and provide time to answer any questions. Morphine increased slowly over time has been proven to be safe and effective in managing pain in chronic conditions, including cancer and at the end of life. Low doses of morphine are indicated for the management of dyspnea. Proper treatment of pain and shortness of breath with morphine can lead to adequate pain and symptom control and an improved quality of life during the patient’s end-of-life journey.