Strong opiates
Morphine is considered the
cornerstone of pain relief for severe
pain. It is relatively cheap and
available in many forms. Table 3
lists the formulation and doses of
commonly used strong opioids.
The dose of morphine required
to achieve pain relief in different
individuals varies. Therefore, the
dose needs to be adjusted according
to the patient’s reaction (Bond
and Simpson, 2006). In acute pain,
immediate release oral morphine
liquid takes approximately 20
minutes to up to an hour to be effective. Morphine is metabolised
in the liver, many metabolites are
conjugated with glucuronic acid
and excreted via the kidneys. Care
needs to be taken in poor renal
function, due to its high plasma
concentrations leading to increased
sedation and respiratory depression
(Bond and Simpson, 2006).