Doctor, I have unbearable pain why don’t you prescribe me Morphine?
Very common conversation in pain clinics that sounds intuitive, someone in pain and a medical professional who have capacity to prescribe the strongest pain killer that humanity has invited, but hang on a second, isn’t that too good to be true?
Morphines are indeed the strongest pain killers that humanity have invited till this point in time, in fact without Morphines and Anaesthesia we could have never been able to reach the advances that we had in offering complex safe surgery to patients. They are excellent pain killers BUT when it comes to acute pain, what means new onset pain like the one related to surgery. When pain becomes long standing; chronic, Morphines turn in to a recipe for disaster as our system inevitably gets used to them and we need to increase the dose to get the same effect, they are highly addictive medications, can cause long list of side effects such as constipation, affecting endocrine and immune system, suppressing breathing and more importantly in large doses for long time they work paradoxically by worsening pain a phenomenon known as opioid induced hyperalgesia where the management is counterintuitive by stopping Morphines!
At certain time in medical practice, when the picture was not entirely clear and medical professionals were liberal in prescribing Morphines for long standing pain, a catastrophe happened in the form the so-called opioid crisis especially in North America and to a degree in Europe.
Morphines remain valid options though in specific situations such as cancer related pain in a dying patient as a palliative measure and some other case by case decisions.
As a conclusion, when your doctor refuses to prescribe strong Morphines for chronic long-standing pain, that’s not because they are not on your side, in fact, it’s entirely the opposite, they want to help you avoid consequences that they are aware about, saw before and just wanting to stop you from going down this slippery slope.