Morphine Manual

Important Caveat:  The following instructions are eccentric to my mother and her peculiar pain and health profile. They should not be used by anyone else to any purpose, including self-administration of narcotic pain medication or as a substitute for or adjunct to one's own physician's orders. If you are suffering pain, seek the advice of your physician.

Sliding Scale for Morphine Administration for Pain Experienced on 11/12/08:

Scale Parameters	Amount in mL	Amount in mg
*Low (beginning)	0.125	2.5
Can give up to:
High (end)	0.250	5.0

Further Instructions:

• A dose will start to work within 10 - 20 minutes.
• This scale and these instructions are for first time use for Mom in her present "narcotic naive" (meaning, someone who has never taken narcotics for pain) state.
• *  This amount can be taken every 20 minutes until Mom is comfortable. This strategy is known as "loading up" and helps create a dose overlap effect until a comfort level is reached.
• Once the dose which achieves comfort is reached, this dose, up to 5 mg, can be administered every hour as needed.
• If pain continues to escalate despite above dosage instructions, call Hospice and check to see if any of the following symptoms apply:
  1.  Any increment of loss of lower extremity use
  2.  Increased urinary incontinence beyond normal
  3.  Bowel incontinence
  These could be signs of a spinal compression fracture.
• Stop administration in the absence of pain and the presence of comfort if these two conditions last beyond 1 hour.

Possible Side Effects:

• Nausea: Can administer metaclopramide
• "Loopiness"
• Sedation
• Keep in mind the typical adjustment period for someone who is "narcotic naive" is 3 days. After adjustment period, above symptoms should disappear.

Additional Notes:

• The morphine to which the above instructions apply is Morphine Sulfate, an Oral Solution to be taken by mouth or under the tongue.
• A syringe is provided in the package which is marked from 0.25 mL - 1.0 mL, in .25 mL increments. This means that I have two dosage increments up to 0.25 mL. Obviously, the above scale is designed for low usage.

    Morphine Manual Update:  The immediately previous link will take you to a post at my main journal which details a conversation I had with a Hospice RN that elucidated, in detail, the use of morphine for air hunger, including what effect morphine should and, more importantly, shouldn't have on the patient.