Morphine is the archetypal narcotic medication. Because it is a short-acting opioid, its use has been limited to the management of acute pain. The development of extended-release formulas have resulted in the increased utilization of morphine in pain clinic conditions. This page documents the history of morphine use in pain clinic treatment, and describes the metabolism, pharmacodynamics, formulations, and effectiveness of the currently available extended-release morphine medications.
Morphine was the most important narcotic medication used to treat acute and cancer pain. However, morphine is a short-acting pain clinic medication, and the frequency of administration necessary to maintain adequate blood levels made it difficult to use this medication in the pain clinic facility. It was not until morphine was available in a long-acting formula that it became effective for chronic, noncancer pain. With once or twice a day dosing, steady blood levels can be achieved, compliance can be improved, and patients can sleep through the night.
Morphine had a small impact on medical science until the invention of the hypodermic needle by , Alexander Wood, sometime between 1840 and 1850. The invention of the hypodermic needle escalated the use of morphine pain clinic settings. The subsequent development of a commercially available oral form of morphine heralded the discipline of modern pain medicine as we now know it.
Additionally, sustained-release morphine has also been linked to improvement in quality of life and sleep. A longitudinal study of pain clinic patients found greater improvements in functional parameters and social engagement when pain clinic patients were treated with sustained-release morphine compared with immediate-release morphine. found that patients taking sustained-release opioids had improved objective sleep measures recorded by polysomnography, including reduced latency to rapid eye movement sleep, increased time spent in Stage 2 sleep and rapid eye movement sleep, improved sleep continuity, and reduced sleep latency to persistent sleep.