Dear Jane
I can tell you about Oramorph both from my own experience and from what I have seen with my husband (who has dementia).
I was given Oramorph when I was admitted as an emergency with an obstructing Colon Cancer over a year ago, (a month before I was booked for elective surgery). The dose was 10mg and it was effective in relieving a quite nasty pain. It made me feel a bit "high" and quite happy, but I was able to conduct a rational conversation. It is quite short acting (this is the liquid form of Morphine Sulphate), but once I had been admitted to the ward I was given Tramadol, which made me quite sleepy and woozy and I was talking rubbish - I didn't like it one bit.
I had surgery a week later after a week on Tramadol, strong antibiotic drips and rehydrating/glucose drips (didn't eat for a week), and had an epidural in for 3 days after the surgery for pain control, then back on the Tramadol, but was given Oramorph on occasions when the pain was bad. Went home with a bottle of it, but didn't use it, although it has a very nice effect and I was quite tempted, but didn't need it!! Co-codamol dealt with the post-operative pain after I went home.
I had a post-operative obstruction some two months later, which was the most painful thing by far that I have ever experienced (have had two babies without analgesia and would have preferred to do that again!). Again admitted as emergency, where they gave me on Entonox (Gas and Air) but the pain was so bad I couldn't take a full breath in, so it was a waste of time. After a lot of dithering they gave me Oramorph again which helped a lot after they finally got the dose up to 10mg (they gave it to me in stages as they thought I had been taking in the Entonox).
So my own experience is that Oramorph is effective, makes you feel good if a bit drowsy, but wears off within 3 or 4 hours at most.
My husband (aged 62) who has "atypical" early onset Alzheimers, has been in an NHS elderly dementia unit for nearly two years and is now on Morphine Sulphate 10mg twice daily (tablets). Although he can't express it verbally he is clearly in a great deal of spinal pain, which may be due to severe "arthritic" type changes, or may be due to bony metastases from Ca Prostate - he has a raised PSA level, but there is no way they can investigate this by endoscopy/biopsy or scan because of his dementia - he wouldn't lie still in a scanner and couldn't be nursed on a "normal" ward because of his behaviour. A year ago he nearly floored the urologist who tried to examine his prostate via the usual route without properly explaining what was about to happen, although he knew that my husband had dementia - he just muttered something about "a little examination", although my hubby was still at the stage where a simple but direct explanation would have helped.
His consultant psychiatrist has said that they can't do much else for him, but can keep him pain-free. He also has another drug which works alongside the morphine and increases its effect. Apparently some Non Steroidal Anti-Inflammatory Drugs (NSAIDs) enhance the effect of morphine. My Cancer Care nurse suggested that if my husband's pain couldn't be controlled the ward should ask for advice from the specialist pain control nurse from the local Hospice, but at present he seems to be quite comfortable.
The down side of morphine (as with many analgesics) is that it likely to cause severe constipation, which is distressing, and in my husband's case has made his behaviour even more "challenging" - in fact he punched me twice on a recent visit, and has been hitting out at the nurses, but has now been put on another medication to relieve the constipation and I think things are a bit better now. He is doubly incontinent since he went into hospital - he never was at home, and I put the start of this down to fairly heavy sedation when he first went in.
As far as I am concerned, morphine was a great blessing, and I was very grateful to be given it, and grateful that it is controlling my husband's pain. It is not supposed to be addictive when given in a controlled way for severe pain, but frankly when you are in that sort of pain, or in a terminal state, does it really matter? - not to me it doesn't, as long as the medics have a generous supply available.
Sorry, have rambled on, but I tell it as I have experienced it. Hope it has answered some of your questions, but I would ask your Dad's doctor for more information.
I'm glad your Mum is coping, for whatever reason, but I'm sure you will be watching out for her - my GP is convinced that my cancer got the better of me because of the stress of caring for my husband for some years, and because I am "stoical" as he puts it and perhaps I bottled up my grief about the situation more than I should have done - but who knows?
Kind regards
Ruthie
