Without pain?

Explanation of the most common falsehoods, myths and misconceptions concerning opioids

When morphine is administrated, it is a verdict of approaching death.
Morphine or other opiate is necessary when pain does not recede after weaker treatment. It is not related to disease prognosis or life expectancy. When administrated under the supervision of the doctor it does not shorten lifespan. A patient experiencing chronic tumor pain is in danger of death because of the tumor, not because of morphine.

Try to live with the pain for now. If we use morphine we would use our last weapon.
No tumor pain should be left without treatment, because it then becomes fixed in the central nervous system and thus gets worse and worse. The doctor is obliged to treat the pain and must know the fundamentals of opiate administration: there is no pain so great that it cannot be treated with opioids.

Opioids are administered only for tumor pain, always via injection and twice or three times per day.
Opioids are not intended for tumor-related pain only. Precedence is always given to so-called non-invasive forms of medicine – pills, drops, suppositories, and bandages. The frequency of medicine administration depends on the period during which the specific medicine is able to ensure a stable level of analgetic in the blood. Bandages are usually applied every three days.

I don’t want morphine! I don’t want to have cancer, be in pain and on top of that be a drug addict! Once a person starts with morphine, there is no turning back…
Patients who use opioids because of severe pain are in little danger of developing a psychological dependency or addiction. They need their medicine in the same way that a person suffering from diabetes needs their insulin. If they suddenly stopped using it, aside the worsening of pain they would also feel very bad overall – just as a diabetic without insulin or an asthmatic without corticosteroids. However, gradual discontinuing of morphine usage is of course possible and common.

Morphine and other opioids inhibit the breathing center putting the patient in danger of suffocation.
The severe pain alone stimulates the breathing center very strongly. Therefore a patient receiving gradually administered opioids from an experienced doctor has no reason to fear breathing inhibition.

If after receiving morphine the patient vomits, it is a sign of morphine intolerance and it should never be administered to him again.
When using opioids for the first time a number of patients feel uneasy or vomit: it is an often seen but transitory side effect of the entire medicine group. If the doctor realizes it in time and concurrently administers medicine to counteract the vomiting – medicine known as antiemetics – the problem stops and usually does not return.

If after the first administration of opioids the patient sleeps through the whole night, the dosage was probably dangerously high.
Often the patient is so exhausted from severe pain that the moment they are relieved of it they fall asleep soundly as if to catch up on lost sleep. Only after compensating for this sleep deficit is it possible to evaluate how strongly the patient is inhibited by the opioids. Such inhibition is common, but luckily transitory.

Instead of a proper painkiller the doctor put some kind of bandage on me! I’ve had it for three hours already and the pain has not gone away one bit!
Transdermal application of opioids (through the use of bandages) is a modern and highly effective method. The effect begins 12 hours after first use and after that its level in the blood is stable and it is sufficient to change the bandages every three days. However, during the first 12 hours the patients feels no relief and thus must have access to a different analgetic.

Morphine is so powerful that it will conquer any pain. It is the most effective medicine.
Morphine is an effective analgetic but it is by no means the most effective from the whole broad family of opioids. Just the opposite – some types of pain will not go away when morphine is administrated during nerve impairment and a much better result can be achieved from administrating antiepileptics, for instance. In practice morphine is broadly used because of its availability and the variety of its medicinal forms.

Morphine and other opioids are extremely dangerous because of their side effects and are not suitable for older patients.
When an experienced doctor administers morphine in accordance with legal rules, it is no more dangerous than most modern medicines. Every medicine has side effects. However, when dealing with older people, administrating opioids for great pain is much safer than the often seen practice of administrating antipyretics and non-steroid anti-inflammation medicine.

How can medicine be used against chronic tumor pain?

• Use the medicine regularly and as prescribed by the doctor. If the pain goes away it means that the treatment is successful, it is not a reason to stop using the medicine! The “settling” of the treatment may take several days.
• When new or worsening pain occurs, administer as “first aid” only that medicine which was prescribed for it by the doctor. Do not increase the amount of medicine used nor shorten the intervals. If your usage of “SOS medicine” is on the rise contact your doctor.
• Pills should not be crushed, broken or diluted. This can change their effect. If you should do otherwise with a specific medicine, your doctor will tell you.
• Do not use any other medicine without first consulting your doctor.
• Remember that even vitamin or food supplements may change the effect of the medicine.
• When dealing with older, tired or sleeping patients, always check to make sure the medicine is being properly used.
• Do not be afraid to ask your doctor for a detailed explanation of how to administer the medicine. A good method is a to have a detailed timetable for a day or a week.
• When taking a new medicine inform yourself of the possible side effects and try to endure them for a reasonable length of time. If they persist too long, contact your doctor.
• Feared side effects of opioids (malaise, vomiting, tiredness) are transitory and the body will adjust to them quickly. However, constipation caused by opioids will not go away and it is necessary to fight against it throughout the treatment.
• If your pain is effectively lessened by a certain analgetic, but its form or method of administration is not suitable for you, discuss it with your doctor. It is often possible to find a different method of application.
• If you regularly drink alcohol do not hesitate to tell your doctor. A reasonable doctor will understand that when under severe pain, abstinence is difficult for you and will appropriately modify your treatment.

Pain hurts more when we face it alone. It is weaker when we can share our suffering with someone else. Thus we must not try to bear and stand everything alone no matter the cost.

MUDr. Marie Goldmannová

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