A patient with severe pain from cancer or other cause may benefit from parenteral morphine rather than oral medication. Certain factors can help identify the patient who should be considered for the parenteral route.
Indications for use of parenteral (IV or SC) morphine:
(1) oral route not available due to gastrointestinal disturbance or other cause
(2) acute exacerbations of pain require rapid titration of pain medication
(3) severe incident pain
(4) poor compliance to oral regimen (either by the patient or by an organization being unable to comply with the drug schedule for whatever reason)
(5) concerns about drug abuse or diversion (the theory being that a solution might be harder to take or sell than pills, but a determined drug user could use the parenteral solution)
Advantages of continuous infusions for administration:
(1) less than painful than intermittent injections
(2) more convenient to administer, especially if patient-controlled analgesia is used
(3) do not have a bolus effect
(4) usually result in lower required doses
Patient-controlled analgesia can give a patient a greater sense of control. It is appropriate provided there is appropriate attention to patient selection and education.
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