Question:
Female, 60 years old, Unknown Subtype
My sister is on hospice with cardiomyopathy. She has been prescribed morphine for pain, but it seems to be making it worse. She appears to be having symptoms of toxicity at a very low dose. She often reacts differently to medications and I’m wondering what we can give her? Any suggestions will be considered.
Nurse Lynn’s Response:
I’m sorry to hear about your sister’s condition. Managing pain for our individuals on hospice care, can be challenging, especially when there’s an unusual sensitivity to medications like morphine. While I am not a doctor, I can provide some considerations and suggestions that you can discuss with her hospice care team:
1.Reassess Morphine Dosage
- – It’s possible your sister is unusually sensitive to morphine or experiencing side effects that mimic toxicity, such as respiratory depression, confusion, or hypotension.
- – Her hospice team may adjust the dose or frequency or try a different route of administration.
2.Alternative Pain Medications
- – Fentanyl: This opioid can be considered as an alternative. It may be easier on her heart because it causes less histamine release and hypotension.
- – Hydromorphone (Dilaudid): Another opioid option, often used when morphine causes intolerable side effects.
- – Methadone: Occasionally used in hospice for pain control, it has unique properties that make it effective for certain types of pain, though it requires close monitoring.
- – Buprenorphine: A partial opioid agonist that may have a lower risk of respiratory depression.
3.Non-Opioid Options
- – Acetaminophen: For mild to moderate pain.
- – Topical Analgesics: Such as lidocaine patches for localized pain.
4.Consult the Hospice Care Team
- – Hospice teams are specialized in providing comfort and addressing medication sensitivities. Let them know about her reactions so they can tailor her treatment plan.
- – If necessary, request a consultation with a palliative care pharmacist or pain management specialist.
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