Pain Management – Morphine Sulfate
Morphine belongs to the opioid analgesics class of drugs and is used to manage moderate to severe pain. It is recommended for pain severe enough to warrant daily use and for which alternative treatment options are inadequate such as in the palliative care of terminal cancer patients. For pain that is present throughout the day and night, a long-acting opioid analgesic is recommended. The dose to use is determined by the patient’s age and is adjusted according to the patient’s response. There is an overlap between toxic and therapeutic concentrations of morphine.
For analgesia:
- Bolus IV over 5 minutes: 0.05-0.2 mg/kg/dose. Repeat as required, usually Q 4 hours. May also be given IM or SC.
- Continuous IV infusion: 10 to 20 mcg/kg/hour
Mechanism of Action
Morphine binds to specific G-protein-coupled opiate receptors in the CNS. It directly inhibits the spinal cord dorsal horn pain transmission neurons and therefore alters the perception of and response to pain stimuli. It also causes generalized CNS depression.
Hints for Monitoring
Monitoring the patient’s pain, sedation, and blood pressure scores is recommended. All patients should be monitored for adequate ventilation (pulse oximetry and respiratory rate) and level of consciousness. Patients on a continuous infusion of morphine should be monitored for the entire duration of the infusion.
Side Effects
The side effects of the drug include:
- Respiratory depression
- Severe constipation, nausea, vomiting
- Addiction
- Hypotension, bradycardia.
Drug Interactions
- Should be used with extreme caution monoamine oxidase inhibitors (MAOIs)
- It causes profound sedation, respiratory depression, and death when used with other opioids, anxiolytics, antipsychotics, and alcohol.
- May increase the anticoagulant effect of warfarin
Adverse Effects And Interventions
Constipation is one of the most frequent side effects of using morphine and opioid analgesics among patients.
If mild, constipation may be treated by encouraging patients to drink lots of liquids, around 2000 to 3000 mL/day, if not contraindicated medically. Assist the patient in taking at least 20 g of dietary fiber per day. Fiber adds bulk to stool.
If severe, pharmacological agents such as bulk fiber, stool softeners, oil retention enema, and chemical irritants such as castor oil may be prescribed.
References
American Pain Society (APS). Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 7th ed. Glenview, IL: American Pain Society; 2016
American Society of Regional Anesthesia and Pain Medicine. (n.d.). Treatment options for chronic pain. Retrieved October 22, 2020, from https://www.asra.com/page/46/treatment-options-for-chronic-pain
Centers for Disease Control and Prevention (CDC). (2015) Common elements in guidelines for prescribing opioids for chronic pain. Retrieved October 22, 2020, from https://www.cdc.gov/drugoverdose/pdf/common_elements_in_guidelines_for_prescribing_opioids-a.pdf.
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Question 
Pain Management – Morphine Sulfate
Select a medication used for pain management and review available evidence and treatment guidelines to determine appropriate therapeutic options.
Pain Management
Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including CAM.
In addition, share an example where you have observed an adverse event from a pain medication and explain the management taken regarding this adverse event.
If you do not have an example, select an adverse event from the pain medication and explain what interventions you could make to mitigate this adverse event.
Include references (within the last 5 years) using APA format.