Therapeutic Uses of Morphine

With the exception of local application of ethylmorphine to the conjunctiva or the tympanum to produce hyperemia, there are no rational local uses of opium alkaloids. These drugs are not local anesthetics and relieve pain only by central actions. Indeed, irritation and vesication may result from opium plasters, ointment, or washes applied to the skin or mucosa. 

Although morphine produces some degree of sweating, it is a very poor diaphoretic when compared with pilocarpine or methacholine. The sweating caused by Dover s powder is mainly due to the ipecac content. The use of this powder as a diaphoretic for aborting the onset of colds due to exposure may conceivably be based on the same rationale as suggested with alcohol. 

Pain is a chief diagnostic sign for the physician, and its total abolition may seriously handicap the discovery of the nature of the patient s illness. It has been said of morphine that it not only puts the patient to sleep but also puts the physician to sleep. Although it is generally unwarranted to make the diagnosis at the cost of unbearable pain, nevertheless there are certain conditions in 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

The use of opiates in obstetrical analgesia is a highly specialized field requiring considerable experience and sound judgment to ensure safety. Morphine has been combined with scopolamine in twilight sleep, but this mixture is not used nearly as much as formerly. Various combinations of meperidine, barbiturate, scopolamine, paraldehyde, and the inhalation anesthetics have made morphine less popular in obstetrical work. The opiates are powerful respiratory depressants. The fetus is especially susceptible to morphine, which greatly increases the incidence of asphyxia in the newborn. Morphine and its derivatives are particularly contraindicated in premature labor because of the untoward effect of such medication on the premature infant. 

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