Using IV Morphine To Control Severe Pain Does Not Lead To Drug Addiction
Question: My friend’s daughter was involved in a car accident recently. She had serious injury to her back and her kidneys. Because she was in such great pain, her doctors put her on an IV drip of morphine for several weeks. I have heard that morphine is a drug and can cause addiction. Do you think the doctors did the right thing and will she become a drug addict in future?
You have a very interesting question. Obviously you know this family very well and want the best for this girl. However, your concern about morphine treatment leading to future drug addiction is not true.
Pain is something that all of us have experienced. A child can have pain and discomfort when he receives immunization or when his tooth comes out. When children fall and get hurt, there is pain from the injury. Pregnant women experience severe pain during labour and childbirth. Those who have cancer often suffer from excruciating pain when cancer cells invade the body.
There is a strong cultural belief that one should endure pain, and pain can strengthen a person’s character. Although there may be some truth to this, recent research, however, clearly shows that severe and recurrent pain can be harmful for the body. Pain can affect a person’s immune system, and reduce the body’s ability to fight infections. Chronic pain not only makes a person irritable, it can lead to severe depression and suicide. Students suffering from pain find it difficult to pay attention in class.
Many people assume that newborn babies don’t feel pain as much as older children, and they don’t remember their painful experience. Research actually shows quite the opposite. Newborns can feel pain just like everyone else. Exposure to severe pain makes them hyper-sensitive to pain, even years later.
As a result of these research findings, health care professionals, including physicians, are paying more attention to prevention and treatment of pain in their patients. In many hospitals, analgesic creams that can numb the skin are often used before intravenous (IV) infusions are being started, especially in children. Some hospitals are organizing ‘pain management teams’ that involve pharmacists, nurses, and doctors to help patients with severe pain.
Pain is caused by chemicals produced around an injury, and wherever there is inflammation. By itself, pain does have a purpose: it tells us not to move the injured site so that healing can occur. However, when there is a serious injury, recovery does take much longer time. Holding the injured area still for a long time can actually cause complications by itself. Laying in bed for too long can cause blood clots in the legs as well as back sores. Therefore, it is important to control the pain so that the person can start to move about after a period of rest.
Mild to moderate pain can be controlled by comforting, distracting (like blowing air at the scraped knee of a child), or using simple pain medicines like acetaminophen or ibuprofen. However, severe pain requires stronger medicine.
One of the most effective pain medicine is morphine. It has been used for many decades by physicians to treat severe pain. However, because drug addicts have used morphine and a related substance called heroin, morphine use was severely restricted for many years. Even dying cancer patients with severe pain, unfortunately, were not given morphine because of the fear that they may get addicted on their death bed!
In the last ten to twenty years, much research was done to understand how we feel pain, and how to control severe and chronic pain. As a result, more emphasis is being placed on the proper recognition of pain, and the early use of effective pain medications, as well as other methods that can reduce pain.
One of the advances of pain management is the use of continuous morphine infusion, through an IV drip, so that the dose of medicine can be adjusted carefully according to the level of pain. This is very important because if the dose is too low, it is not effective; and if it is too high, there can be dangerous side effects. By careful adjustment of the dose, many patients can have their pain controlled very well so that they can move around with tolerable degree of pain, and at the same time prevent complications like blood clots and bed sores.
Research has also shown that giving powerful medicine like morphine does not result in drug addiction. Those addicted to IV morphine or heroin do so because when they inject these drugs rapidly into their body, they experience an intense feeling of euphoria, and it is this feeling that they are seeking. When morphine is given through an IV at a steady rate in the hospital, this does not result in any euphoric feeling.
It is true that if a person needs IV morphine continuously for several weeks because of severe pain, the medicine needs to be reduced slowly when the condition gets better. This is because the body has become adjusted to the medicine. If morphine is stopped suddenly, the person can experience side effects. However, this doesn’t mean she is ‘hooked’ onto the medicine, and will get addicted.
We need to understand that many who get addicted to drugs have an addictive personality. Some of them can have underlying psychiatric conditions, but instead of seeking proper diagnosis and help, they resort to experimenting with drugs which have addictive potential. Some of these are prescription medicine, but there are also many non-prescription drugs as well as alcohol.
Unfortunately, because of these people’s addiction, it has made it much harder for physicians to prescribe good pain medications for those who really need them to control their pain. Until society can find a way to prevent drug addiction, the issue of effective pain medications like morphine will continue to be controversial in some people’s mind.
I hope you have a better understanding of the situation after reading this column. I fully agree with the doctors’ approach, and I can assure you that almost certainly she will not become a drug addict because of her treatment.