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FDA-approved usage of Morphine sulfate includes moderate to severe pain that may be acute or chronic. Most commonly used in pain management, it provides significant relief to patients afflicted with pain. Clinical situations that benefit significantly by medicating with this drug include management of palliative/end-of-life care, active cancer treatment, and vaso-occlusive pain during sickle cell crisis. This drug is widely used off-label for almost any condition that causes pain. In the emergency department, it is prescribed for musculoskeletal pain, abdominal pain, chest pain, arthritis, and even headaches when patients fail to respond to first and second-line agents. It is rarely used for procedural sedation. However, for small procedures, physicians will sometimes combine a low dose of morphine with a low dose of benzodiazepine-like lorazepam.
Patients that are actively having acute coronary syndrome are often given morphine in the emergency setting before going to the cath lab. Morphine is a potent opioid; it decreases pain, which in turn leads to a decrease in the activation of the autonomic nervous system. These are desirable effects when a patient is having an MI. Additionally, morphine has hemodynamic side effects that can be beneficial during an MI.
Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.This drug produces most of its analgesic effects by binding to the mu-opioid receptor within the central nervous system (CNS) and the peripheral nervous system (PNS). The net effect of morphine is the activation of descending inhibitory pathways of the CNS as well as inhibition of the nociceptive afferent neurons of the PNS, which leads to an overall reduction of the nociceptive transmission.
Morphine administration can occur through various vehicles. Its administration is most often via the following routes: orally (PO), intravenously (IV), epidural, and intrathecal.
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