The goals must be realistic and achievable. For example, it may not be realistic Many people worry about the use of morphine in palliative care. Morphine and other medications in the morphine family, such as hydromorphone, codeine and fentanyl, are called opioids. These medications may be used to control pain or shortness of breath throughout an illness or at the end of life. Patients and families sometimes worry that There are several options that can be considered for pain relief with bone pain.
The maximum dose of acetaminophen is 4, mg a day. If your mother was receiving regular pain medication at home, the same dosage needs to continue in hospital.
One of two different things may be happening. Your mother may in fact be getting medications just as The common side effects include weight gain, increased appetite, bloating, filling of the face called moon face and filling of the abdominal area. These side Morphine and other opioid medications generally have these side effects: Sleepiness Some level of sleepiness or drowsiness is common when the medication is first started or the dosage increased.
It usually lasts about two to three days. Fatigue Nausea This may occur with the drowsiness. The average age for patients treated with morphine was Of patients treated with hydromorphone, Additionally, race was calculated for this population and the majority of patients treated with hydromorphone or morphine were white, Over the three years, , patients were treated with hydromorphone and , patients were treated with morphine.
These patients were further grouped by medical or surgical admissions and this formed our cohort. In the medical cohort, , patients were treated with hydromorphone and , were treated with morphine. In the surgical cohort, , patients were treated with hydromorphone and , patients were treated with morphine. Over the three-year study period, the use of morphine steadily decreased while use of hydromorphone increased in both medical and surgical groups. A noteworthy change occurred over the study period as hydromorphone overtook morphine as the more commonly used analgesic in surgical patients see Figure 1.
SOI is classified into minor, moderate, major, and extreme. In the medical cohort, for patients treated with morphine, In the surgical cohort, for patients treated with morphine, Our results show that rescue drugs are used more often in patients treated with hydromorphone than patients treated with morphine.
In patients treated with hydromorphone, rescue drug use was 0. The data on length of stay LOS , which was measured in days, showed that patients receiving morphine were in the hospital longer than patients receiving hydromorphone.
In patients treated with morphine, we found that the average LOS was 0. The data shows that the day readmission rate was greater amongst patients receiving hydromorphone when compared to patients receiving morphine. In patients treated with hydromorphone, the all cause day readmission rate was 1. In comparing our hydromorphone and morphine groups by APR-DRG SOI, we found a slightly higher percentage of sicker patients in the morphine group compared to the hydromorphone group in both the medical and surgical cohorts.
The results show that rescue drug use is higher in patients treated with hydromorphone compared to morphine. The main pharmacodynamic difference between hydromorphone and morphine is potency, such that hydromorphone is five to ten times more potent than morphine [ 10 , 15 , 24 ]. Hydromorphone crosses the blood brain barrier faster, resulting in quicker onset and peak of analgesic activity.
A study of nonsurgical patients admitted to hospitals in the United States showed that patients prescribed hydromorphone received nearly triple the strength of opioid when compared to patients prescribed morphine [ 25 ]. This may help explain the greater use of naloxone among hydromorphone patients found in this study [ 13 ]. Adverse events, as defined in our study by rescue drug use, have been directly implicated in increasing healthcare costs [ 26 ]. Patients treated with morphine remained in the hospital for a little under one day longer when compared to patients treated with hydromorphone.
However, day all cause readmission rates were significantly higher in patients treated with hydromorphone in both the medical and surgical cohorts. Historically, shorter LOS has been equated with lower costs [ 27 ]. However, higher readmission rates, which would imply premature discharges, have significant reimbursement implications.
In the new hospital value-based purchasing program, reimbursement rates to institutions can be adversely affected by costs incurred when patients are readmitted to the hospital within 30 days after discharge.
Limitations of our study include the observational nature of the study and the lack of risk adjustments between the groups. Of interest, however, in both medical and surgical study groups, there were more patients treated with morphine alone who were admitted in the severe and extreme severity of illness categories than those treated with hydromorphone. While this may explain that patients treated with morphine stayed in the hospital longer, the higher rescue drug use and readmission rates in patients treated with hydromorphone alone are not in keeping with this observation.
In addition, there are limitations with using day all cause readmission rates because unrelated diseases or acute conditions that may be the cause of an additional hospitalization may be lumped together. Lastly, UHC uses billing data, which has inherent limitations as well.
For example, we are unable to differentiate patients that received patient-controlled analgesia in comparison to an intravenous bolus. The increasing use of hydromorphone over morphine does not appear to be supported by recent literature. Further research in risk adjusted models may help further delineate these observations. Specifically, data on the underlying diseases of the patient populations could help provide insight into the relative risk for these patients. The authors declare that there is no conflict of interests regarding the publication of this paper.
This action changes the way you perceive pain to help you to feel less pain. Hydromorphone and morphine each come in several forms and strengths. The oral forms taken by mouth are most commonly used.
All forms can be used at home, but injectable forms are more often used in the hospital. Both drugs can cause severe side effects and can be addictive, so you should take them exactly as prescribed. If you have questions about how to take your medications, ask your healthcare provider or pharmacist. If you take a controlled substance, your healthcare provider must closely supervise your use of the drug.
Never give a controlled substance to anyone else. This means you can get addicted to it. Be sure to take this drug exactly as your healthcare provider tells you to. If you have questions or concerns, talk with your healthcare provider. A key difference between these drugs is the forms they come in.
The table below lists the forms of each drug. All forms of hydromorphone and morphine are available at most pharmacies. In most cases, generic forms of drugs cost less than brand-name products. Morphine and hydromorphone are generic drugs. At the time this article was written, hydromorphone and of morphine had similar prices, according to GoodRx. Morphine is the most commonly known pain medication. Hydromorphone is more potent than morphine, which simply means that a smaller quantity of hydromorphone has the same pain relieving effect as a larger quantity of morphine.
For example, someone taking 10 mg of morphine may be switched to 1 or 2 mg of hydromorphone. The degree of pain relief is the same. Both morphine and hydromorphone are used to treat moderate to severe pain. Morphine is often the first medication used. For some patients, however, hydromorphone may be a better first choice.
People who are older may have less trouble with side effects such as sleepiness or confusion with hydromorphone. People whose kidneys are not fully functioning may also do better with hydromorphone, because it is removed from the body by the liver not the kidneys.
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