"Palliative morphine"

[Sterlingtimes]

Does the term "palliative morphine" have a particular meaning?

My mother was recently moved from codeine to tablet morphine with a dose of 10 mg every twelve hours. Additionally, liquid morphine could be provided as required at 2.5 mg every four hours. Would "palliative morphine" typically be provided at a higher dose than this?

 

[Kevinl]

Palliative care or medication usually means end of life care, although pain relief is used can be classed as palliative too I understand.
Levels of medication would depend on some variables, age, weight, level of pain being experienced. One for the professionals to decide as to the levels of prescription. K

 

[Palerider]

Does the term "palliative morphine" have a particular meaning?

My mother was recently moved from codeine to tablet morphine with a dose of 10 mg every twelve hours. Additionally, liquid morphine could be provided as required at 2.5 mg every four hours. Would "palliative morphine" typically be provided at a higher dose than this?

My understanding is that pain relief such as morphine is started at the lowest dose that has effect and then titrated up if pain becomes worse and down if too much morphine -the effect has to be balanced against the risk of overdosing. Seems like this is palliative pain relief as opposed to end of life. Sometimes alternatives are used depending on the response to morphine.

 

[Sterlingtimes]

Levels of medication would depend on some variables, age, weight, level of pain being experienced. One for the professionals to decide as to the levels of prescription. K

Thank you for explaining this.

 

[Sterlingtimes]

My understanding is that pain relief such as morphine is started at the lowest dose that has effect and then titrated up if pain becomes worse and down if too much morphine

Thank you. Does morphine radically change behaviour in such circumstances?

 

[SherwoodSue]

I think it is unwise to use end of life and palliative terms interchangeably. They mean different things
Pain management is complex. It is more productive to keep one step ahead of pain rather than remove pain once it has set in.
Background, lower doses of morphine have a role to play here. Patches for example gibe a continuous low dose of the drug
Morphine comes with its complications. Constipation is a common side effect , as is depressed breathing and sleepiness.
The sleepiness may not be unwelcome at true end of life but in the palliative phase a nuisance. Doses are adjusted to balance these issues.

 

[Sterlingtimes]

I think it is unwise to use end of life and palliative terms interchangeably. They mean different things
Pain management is complex. It is more productive to keep one step ahead of pain rather than remove pain once it has set in.
Background, lower doses of morphine have a role to play here. Patches for example gibe a continuous low dose of the drug
Morphine comes with its complications. Constipation is a common side effect , as is depressed breathing and sleepiness.
The sleepiness may not be unwelcome at true end of life but in the palliative phase a nuisance. Doses are adjusted to balance these issues.

Thank you, SherwoodSue, for your kindness in responding to me. I have been reflecting upon this for a few hours. The consultant has used the terms "end-of-life care" and "palliative morphine". Whereas it may be incorrect to use the terms interchangeably, I now wonder whether we have two separately identifiable problems that require immediate consideration.

The first is that my mother has suffered increasing pain following on from the dynamic hip screw operation that was effected nearly two years ago. That more recently became a chronic on acute periprosthetic fracture. Her knees are now locked into a bent position. That requires morphine.

The second is her other mental and physical degenerations that are "end of life". Those may benefit from morphine.

With your help, I suspect we are now dealing with multiple complex conditions.

 

[SherwoodSue]

There may be difficult times ahead. Is you mother confined to bed with this loss of mobility? Increased time in bed is linked to bouts of pneumonia
Pneumonia can become sepsis and the body’s organs can become overwhelmed and shut down At that point patients may be truly end of life.
I think of the word palliative as symptom relieving without an expectation of cure.
We also as human beings do as much as possible to prepare ourselves for the worst. We thereby import distressing emotions from a perceived future into our here and now.
A brief scroll around these posts and you will see many PWD who baffled their medical team by being with us long after they were predicted to pass away.
Try and stay here and now. Take it one day at a time.
Yes I know it’s a cliche but it’s true.
Thinking of you

 

[maisiecat]

My husband is on a morphine patch for pain associated with his parkinsons but he is definitely not on end of life care. If you are not sure how and why they are using morphine I would ask them to explain again.
Its always difficult when you are on an emotional rollercoaster to exactly remember what is said.

 

[Sterlingtimes]

It's always difficult when you are on an emotional rollercoaster to exactly remember what is said.

Thank you. Indeed, I wish I had a video session with the consultant. Fortunately, while I was answering many questions, my wife was there as an observer. I was stressed during the meeting.

 

[Duggies-girl]

My dad was on palliative care for two years, he had alzheimers and oesophageal cancer. Palliative care does not mean end of treatment or even end of life. It means that the patient can have any treatment that does not cause harm.

The operation would have caused great harm to dad so that was a no. Chemo would have caused dad more harm than good so again, no.

An oesophageal stent allowed dad to eat so yes that was a procedure well worth having.

Blood transfusions and iron infusion helped dad so yes, that was fine.

Antibiotics, they made dad comfortable so yes, that was fine.

Palliative radiotherapy would have been good in the earlier days if he had declined but he did so well that it was not necessary.

Dad was on morphine for the last two weeks of his life, I am not sure whether this made much difference to his quality of life or not.

According to dad's oncologist my dad was the perfect advert for palliative care for the elderly.

 

[Sterlingtimes]

My dad was on palliative care for two years, he had alzheimers and oesophageal cancer. Palliative care does not mean end of treatment or even end of life. It means that the patient can have any treatment that does not cause harm.

The operation would have caused great harm to dad so that was a no. Chemo would have caused dad more harm than good so again, no.

Thank you, Duggies-girl, for such an excellent illustration of the benefits of "palliative morphine". I am starting to get the hang of this. Certainly, my mother has suffered greatly from the pain related to her inoperable secondary hip fracture. Paracetamol, with the later addition of codeine, was insufficiently effective. Now on morphine, my mother appears to be uncomfortable but no longer in pain. I notice that she is now drifting in and out of sleep and is not lucid for very long.