Morphine is one of the most effective drugs against moderate and severe pain, but at the same time it is one of the most stigmatized. In this regard, Dr. Juan Pablo Oglio, a specialist in anesthesiology and resuscitation at the Mis Tres Torres Pain Treatment Unit, points out that “the usual question asked by patients when we prescribe morphine is whether they are going to get hooked and whether they will be able to lead a normal life taking it”.
In the face of this stigmatization, the doctor clarifies that the fear of possible addiction is not unfounded, since “continued use of morphine can lead to addiction; there can always be some patients, especially in younger age groups, who can end up developing an addiction”. On the other hand, Dr. Oglio also reminds us that it is necessary to differentiate between tolerance, dependence and addiction.
What is the difference between tolerance, dependence and addiction?
Tolerance involves increasing the doses of the drug to reach the same level previously administered. The specialist at Mis Tres Torres acknowledges that “this is one of the problems with morphine drugs, which have no analgesic ceiling. You start with a low dose and if the patient feels pain, you can increase it. If the pain returns, you can continue to increase the dose progressively.”
This continued use of morphine can eventually lead to physical dependence. In cases where treatment is stopped abruptly, the patient may begin to experience a series of unpleasant symptoms. In the doctor’s words: “it is what we call withdrawal syndrome” and it can manifest itself through different symptoms such as: bad mood, sweating, hot flashes, tremors, nausea, etc.
There is another type of dependence, psychological dependence, which is commonly known as addiction. This occurs when morphine is used to achieve a different psychological state than normal.
Is it possible to reduce the dose of morphine?
It is possible, but the first thing to know is the reason why it has been necessary to gradually increase the dose and determine whether it has been due to tolerance or because the disease has worsened. “If the disease remits, what we try to do is lower the dose of morphine. To do this, it is necessary to carry out therapy with the patient. We must warn the patient that we are going to start reducing the dose and that this process can be complicated. There are people who tolerate it very well, but sometimes withdrawal syndromes are generated,” describes the expert in anesthesiology and resuscitation.
At present, most of the world’s leading medical guides instruct patients to try to use as few opioids as possible in their treatment. The Pain Management Unit follows these guidelines when prescribing treatments. “What we try to do is avoid treatments that involve the use of morphine, but there are pathologies, and even some postoperative procedures, in which its application is unavoidable,” concludes Dr. Juan Pablo Oglio.