Using strong opioids to manage pain

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1 Using strong opioids to manage pain Q1. What is an opioid? A. Opioids are strong pain killers. Strong opioids commonly prescribed by doctors include: Oramorph (contains morphine), MST (contains morphine), Oxynorm, Fentanyl, Oxycontin and Sevredol. Patients who are living with advanced, progressive diseases (such as advanced cancer, heart disease, liver disease, lung disease, kidney disease, HIV and some diseases of the nervous system) may need strong opioids to alleviate their pain when other types of pain relief do not help. This leaflet will focus on the use of oral morphine. Q2. Isn t morphine only used for patients who are at the end of life? A. No. Morphine is given for different sorts of severe pain. Treatment with morphine may be needed to allow you to continue living as comfortable a life as possible. You will be able to go on taking morphine for as long as you need to. The pain killing effects do not wear off with time and the dose can be increased, following advice from your doctor or specialist nurse, if needed. Q3. When do I take it? A. The first strong opioid treatment you are likely be offered is morphine. It is usually prescribed in a form that you can take by mouth, such as tablets, capsules, liquid or sachets. There are two types of morphine. Short-acting morphine (called immediate-release): starts to work after about 30 minutes and usually lasts for about 4 hours. It may be taken regularly every 4-6 hours, or taken as required, usually up to every 4-6 hours. It is also used to control breakthrough pain (sudden, intense pain in addition to background pain) as it works quickly. Short acting morphine may also be prescribed in addition to long acting morphine. The short acting morphine may be taken if you experience pain in between the long acting doses. If you need to take more than 2-3 doses of short acting morphine in a day, tell your doctor or nurse. Ref: PIID373 Date: July 2015 Review: July 2017

2 Q4. Are there any side effects from taking morphine? A. There are some common side effects from taking morphine: Constipation This is a very common side effect. It is important to drink plenty of fluids and take a laxative regularly as prescribed by your doctor. The dose of laxative can be increased or reduced to make sure you pass a soft motion regularly. Sickness If you feel sick when you first start to take morphine, try taking it with food. Your doctor may need to give you some anti-sickness medicine for a few days until the sickness goes away. Sleepiness This is most common when you first take morphine or when the dose is increased. It should improve after a few days. Q5. Will I become addicted to morphine and unable to stop taking it? A. No. If you no longer need to take morphine, your doctor will reduce the dose gradually. Q6. Will morphine always relieve my pain completely? A. Although morphine is a very good pain killer, it is not helpful for all types of pain. Other treatments may be needed and suggested by your doctor or nurse. Q7. What do I do if I get pain between the regular doses of morphine? A. If the pain is mild, Paracetamol may help. (Do not take more than 8 Paracetamol 500mg tablets in 24 hours). If it is more severe you should take a dose of short acting morphine (see Question 3). If you need more than 2-3 extra doses in a day, tell your doctor or nurse. Some people find that doing certain things like having a bath or going for a walk brings on the pain. Your doctor or nurse may suggest you try taking a dose of short acting morphine before you start doing something that brings on the pain.

3 Q8. How do I store morphine at home? A. Keep in their original containers, clearly labelled and store safely at room temperature in a dry place, preferably in a locked cupboard, out of reach and sight of children. The label should provide storage instructions but check with your pharmacist if you are unsure. Q9. How will I know if the morphine is not going to work for some of my pain? A. You may still have pain despite taking bigger doses of morphine and may feel unwell in one or more of these ways: more sleepy than usual feeling sick more of the time restlessness or jumpiness bad dreams Do not worry if this happens. Tell your doctor or nurse. Your doctor may reduce your dose of morphine and suggest other treatments to help the pain. Q10. What do I do with unused morphine? A. Unused morphine should be returned to the pharmacist for safe disposal. Do not flush them down the toilet or throw them away. Q11. Can I drive? A. It is essential that you do not drive unless you feel 100 per cent safe to do so. You should not drive for at least five days when you first start taking strong opioids, or if you are changing their dose. Sometimes longer is needed. You must discuss this with your doctor. Please see Patient Information Leaflet: Information on Driving Whilst Taking Opioids Useful contact details: DVLA Drivers medical enquiries Tel No:

4 Q12. Can I drink alcohol? A. A small glass of wine, beer, or spirits may help you feel better and improve your appetite. It is best to avoid taking more than this as you may become too drowsy. ADDITIONAL INFORMATION Please tell the clinician who prescribed the medication about any other medication you may be taking. Please discuss this leaflet with your doctor or nurse who will answer any questions you may have. Information that is given in this leaflet should be read with any patient information leaflet provided by the manufacturer. Repeat prescriptions may be obtained from your GP or hospital doctor Source of information taken from: NICE (2012) Managing pain with strong opioids in people with advanced, progressive disease, Information about NICE clinical guideline Lothian Health Board Palliative care guidelines - patient information leaflets Drug driving: guidance for healthcare professionals July 2014 https://www.gov.uk/government/publications/drug-driving-and-medicine-advice-forhealthcare-professionals Analgesic drugs and fitness to drive. Palliative Care Formulary 5th Edition palliativedrugs.com 2014

5 Languages/ Alternative Formats Please ask if you require this information in other languages, large print or audio format. Please contact: Fadlan waydii haddii aad warbixintan ku rabto luqad ama hab kale. Fadlan la xidhiidh Jeżeli chcialbyś uzyskać te informacje w innym języku, w dużej czcionce lub w formacie audio, poproś pracownika oddzialu o kontakt z biurem informacji pacjenta (patient information) pod numerem telefonu: 如 果 你 需 要 這 些 資 料 的 其 他 語 言 版 本 大 字 体 或 音 頻 格 式, 請 致 電 查 詢 إذا كنت تود الحصول على هذه المعلومات بلغة أخرى باألحرف صوتي يرجى االتصال بالرقم التالي الكبيرة أو بشكل شريط

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