Morphine: True or False?

I read somewhere the following about Morphine:

The greater amount of pain an individual is in, the more Morphine they can tolerate.

For instance, someone in severe pain can take a shot of Morphine that would, under normal circumstances, be fatal.
Is this true, if so, why?

Answer: Usually, but but not always true. Morphine depresses the respiratory drive, so a lot can make you stop breathing. But with severe pain, adrenaline and other body chemicals are secreted which tend to raise blood pressure and respiratory rate, so the morphine may have less respiratory effect on an individual if they are in pain than it would if they were not in pain.

But how any given individual will react to a drug is never certain.


As a tangent, QtM-
I heard something, from a person who’s not in the medical professions, but went through surgery and was on morphine at the time. He claimed that he was told that when you’re in severe pain, as he was, there is no risk in giving large amounts of morphine (and its cousins) to relieve the pain - the patient will not become an addict. He said it was believed, until quite recently, that the doctors should be careful in giving opiates to relieve pain, because of the risk of addiction, but modern medicine (i.e. since a few years ago) think that it’s not a problem.
So what’s the SD?

Precisely. This is the sticky issue with drugs is that tolerance is a very nebulous thing. It can change within an individual on an hourly basis for no reason, or it can drastically change based on the environment and/or situtation. Also, oddly, epi levels have nothing to do with this process of tolerance. Although obviously they can work as antagonists.

Morphene is a great thing, you take as much as you need, until it crosses the tolerance threshold,suppresses your respiratory drive and you fail to oxygenate properly, go septic and die.

Damn field medics.

damn submit button…i meant apneic.

An old HS buddy of mine spent 16 days in a burn unit, tons of heavy painkillers. After the fact he said if he had a choice now between the pain of the burns or morphine withdrawl, he would rather have the pain.

Addiction should not be a concern when treating either acute (ie broken bone, surgery) or malignant (ie cancer) pain. It’s a non-issue.

Problems may arise when it’s time to come off the meds, but that’s due to the patient’s individual tendency towards chemical dependency or drug abuse, and unrelated to being given loads of pain-killers when having loads of acute or malignant pain.

But physicians should not generally prescribe narcotic pain killers for chronic pain such as your average backache or headache without a whole lot of caution.

Frankly, I know that is not the typical response of most burn survivors.

My friend had a slipped disc and was walking around like Quasimodo for three months before his surgery. The heavy painkillers came into the picture after surgery. Before he was on a pill which was paracetamol/codeine.

FWIW, I spent 30 days in the hospital after a car wreck. For the entire month, I received hourly injections (when I was awake) of Demerol, a synthetic narcotic much like morphine. I experienced no withdrawal that I could detect, and I had wondered about it in advance.

Umm, i ass/u/me that you were addressing my post. To which i reply:

Tolerance has a lot to do with usage, but it also has the tendency to vary quite a bit with total abstenance. IN the post i was quoting, the high resistance to the effects of morphine are not solely attributable to the antagonist of epi.

BTW, that little button at the end of each post that says “quote” can be quite useful. :wink:

Actually, I was addressing the Gaspode. He directly asked me a follow-up question.

As for your issue, tolerance is a separate phenomenon, in that smaller subset of patients that are both chronic opiate users and need acute pain relief. My reply was framed for the more typical patients who are opiate-naive.

Most doctors don’t , and never really have had, a problem with prescribing even strong pain medicine for problems they know are legitimate. Cancer, broken bones, burns, etc…no problem. Most of the conbtroversy comes in things like chronic low back, neuropoathy, headaches, abd pain, etc., where you have to rely more on subjective complaints with sometimes very few objective findings or ways to measure the problem.

On a completely different tangent…

Demerol kicks ass.

I could make a weekend out of 200 units of Demerol and clean sheets.

I used to belong to a chronic pain support group whose which lobbied for better treatment of chronic pain patients by doctors. While these were end-users, not doctors, the general consensus of the group was that:

A) The worse the pain, the higher the dose of pain medication you could take without getting sleepy or suffering other sedative effects, and the longer you could take them without building up a tolerance and/or becoming physically dependent.

B) Almost nobody taking opioids for pain rather than for recreational purposes will become addicted. There was a lot of discussion about three studies, which showed that the number of patients who developed “problem usage patterns” with opioids after being introduced to them in a pain management setting was three out of 12,000, five out of 25,000, and zero out of 3,000 (or numbers very similar to those; it’s been a couple years since I read up on them personally).

Well, Dilaudid was given to me in the hospital a few years ago for a kidney stone and it is a good thing they don’t sell that stuff over the counter - I was an addict after the first shot.

Luckily I don’t have access.

Oh, and one other thing I forgot to mention that I learned from the many opioid users in the chronic pain support group was that emotional reponse to opioids breaks down pretty much into three equal categories: about a third of people have a euphoric reaction to opioids, another third have no real reaction, and the final third have a dysphoric reaction to it or find that it makes them feel ill (nausea, dizziness, and sleepiness were the three most common symptoms reported by the “bad reaction” people). And yet it seemed to ease pain in almost everybody (only two members of the group reported that they had no pain-relieving effects from opioids … and they had other problems as well) regardless of the emotional reaction.

I was heavly medicated after having open heart surgery the hallucinations and dreams were absolutely phenomenal, all good stuff. I didn’t think to ask what they were giving me but I later related my experence to another doctor his reply “now you know why people become drug addicts”.

Chorpler - put me in that third who has no reaction. Morphine is not my pain-killer of choice.

Actually, and this is just me, if you know the pain has an end time, it’s not that bad. (e.g., You will have pain and swelling the first few days after surgery.)

On the other hand, and I think this is true for everyone, chronic pain is probably as bad as being slightly drugged up - as far as making one grumpy and stupid and paranoid and weird.