Sweet, Drinkable Pain Relief: This Medicine Eases Kids' Suffering!

Sweet, Drinkable Pain Relief: This Medicine Eases Kids' Suffering!

As a parent of a child with cancer, the most daunting challenge is often administering medication, especially for children under three years old who have difficulty eating and exhibit strong resistance. So, what should we do in such situations?

Today, let’s explore a special option: a drinkable, fruit-flavored liquid morphine available for these young patients.

Special note: The introduction of opioid medications in this issue and subsequent ones is based on the needs of patients and does not involve any drug recommendations. Parents and healthcare professionals should carefully consider local medication availability and each child's specific circumstances when making choices.

Hospital-White Coat Crying Syndrome

In pediatric oncology, aside from solid tumors, most pain experienced by children is temporary, occurring during treatment—lasting from a week to about a month. This can recur throughout the treatment process, easing as the underlying disease is controlled.

Beyond the pain caused by the disease itself, children undergoing procedures like bone marrow aspirations also experience pain related to the procedure or discomfort from special positions during examinations, along with pain from activities like coughing or straining during bowel movements.

Children are different from adults; while adults may endure discomfort by gritting their teeth, children, whose cognitive development is still maturing, can be deeply affected by acute procedural pain if it is not recognized and managed promptly. This can leave psychological scars, making it difficult for them to cooperate during future treatments.

However, most children are very resistant when it comes to taking medicine, especially younger ones who cannot swallow pills.

For pediatric cancer patients needing morphine for pain relief, if a child weighs less than 20 kilograms (especially under 10 kilograms), the dosage must be calculated based on their weight, requiring existing morphine tablets to be split to meet dosage requirements. However, splitting them can make the bitter taste more pronounced, complicating the administration process for parents and making it harder to calculate the precise medication dose.

Failing to address pain or being unable to manage it effectively due to a child's reluctance to swallow pills not only increases physical suffering but can also lead to psychological issues, resulting in severe reactions like “Hospital-White Coat Crying Syndrome”: crying at the mere mention of a hospital visit or running away upon seeing a white coat. If parents cannot soothe their children, treatment could be delayed.

Oral Morphine Solution: A Sweet, Drinkable Pain Reliever

To address the challenges mentioned above, I would like to introduce a pain medication—oral morphine solution. It is a liquid form of rapid-release morphine that acts quickly, similar to morphine tablets, but in a liquid formulation.

Many hospitals are equipped with oral morphine solution, making it accessible in various locations. Additionally, a 30 mg bottle typically costs around 10 yuan, sufficient for a child's 24-hour usage, making it quite affordable.

We know that for advanced cancer patients, eating can often be very difficult, and even small pills can be hard to swallow. Thus, this liquid form of pain medication is very convenient. Especially for children with feeding tubes, and where conditions do not support the use of subcutaneous pain relief pumps, many doctors turn to fentanyl or buprenorphine patches for pain management. However, these pain medications are more suitable for continuous background pain, while children may experience breakthrough pain due to procedural events (like operations, examinations, activities, involuntary coughing, or straining during bowel movements), which can be challenging to manage.

Using injectable morphine to control this short-term breakthrough pain is also an option, but the pain caused by injections should not be overlooked. Some children may develop a conditioned response: once they realize that mentioning their pain leads to an injection, they may start to hide their pain.

At this point, the advantages of oral morphine solution as a liquid, rapid-release, home-accessible, and safe morphine preparation become evident. More importantly, this oral morphine solution is fruit-flavored, making it particularly suitable for younger patients who are resistant to taking medicine, especially those requiring doses of less than 5 mg of morphine. The concentration is 2-3 mg/ml, so for a low-weight child of 5 kg, a dose of 0.5-1 mg can be easily measured with a syringe as 0.25-0.5 ml, avoiding the difficulties of splitting pills.

When Can It Be Used?

Based on the points above, here are the suitable groups for using oral morphine solution:

1. When the doctor informs you that your child needs “morphine titration,” and if the child can eat, this is the preferred option. “Morphine titration” is the process of exploring the best 24-hour pain relief dosage using rapid-release morphine, which can then be converted into controlled-release morphine tablets.

2. Pain related to cancer infiltration or metastasis, where short-acting pain relief medications assist with anti-cancer treatment.

3. Pain from procedures like bone marrow aspirations or other relevant operations.

4. Event-related pain caused by examinations, activities, coughing, or straining during bowel movements.

5. Children who are using controlled-release medications like morphine extended-release tablets or fentanyl patches to manage background pain but also experience difficult-to-control breakthrough pain, especially those at home.

Usage Precautions

Although oral morphine solution is convenient, it does have limitations. First, as a rapid-release liquid formulation, it is not suitable for controlling continuous pain. Similar to other opioid tablet forms, it may cause side effects such as nausea, vomiting, constipation, dizziness, drowsiness, respiratory depression, and skin itching. However, due to its liquid form, gastrointestinal side effects are typically milder.

Finally, I would like to remind all parents to pay attention to the following points when using oral morphine solution:

1. Initial use must be guided by specialized healthcare professionals.

2. Children, especially younger ones, must use it under parental supervision.

3. It is not recommended for children to use the straws provided with the medication for direct sucking, as they may struggle to control the amount ingested, leading to underdosing or overdose. Parents should measure the prescribed dosage accurately with a syringe before administering.

4. Due to its fruit flavor and liquid form, parents must ensure proper storage of the medication to prevent accidental ingestion by other children out of curiosity, which could lead to side effects or serious negative outcomes.

5. Leftover medication must be returned to the hospital pharmacy or disposed of according to local healthcare personnel's instructions, to avoid misuse or unauthorized use by others.

Today, we have learned about fruit-flavored liquid morphine. Future columns will continue to introduce the specific usage of common opioid medications for children, so parents can choose based on their child's specific circumstances.

In the realm of opioid pain relief, are there any medications you would like to learn about? Feel free to discuss in the comments! The reader who leaves the most liked comment will receive a copy of “No Pain, No Happiness—Expert Advice on Pain Management” co-authored by Director Guo!

Column Author: Guo Yanru  

Deputy Chief Physician, Palliative Care Department, Cangzhou People's Hospital, Hebei Province  

Editor: Zuo Jia, Xia Yu  

Layout: Ying Tao  

Proofreading: Xiu Xiu