From the Guidelines
Morphine should not be given for gastroparesis pain as it can worsen the condition by further slowing gastric emptying, potentially creating a cycle of worsening symptoms and increased pain. According to the most recent and highest quality study, 1, opioids like morphine are not recommended for treating gastroparesis-associated abdominal pain. Instead, consider medications specifically designed to treat gastroparesis, such as metoclopramide (10mg three times daily before meals) or domperidone (where available, typically 10mg three to four times daily). For pain management, acetaminophen is often safer than opioids. If pain is severe and persistent, low-dose tricyclic antidepressants like amitriptyline (starting at 10-25mg at bedtime) or nortriptyline may help with visceral pain.
Some key points to consider when managing gastroparesis pain include:
- Non-medication approaches, such as dietary modifications (small, frequent, low-fat, low-fiber meals), avoiding carbonated beverages, and managing blood glucose levels if diabetes is present
- Medications to accelerate gastric emptying, such as metoclopramide or domperidone
- Medications for visceral pain, such as tricyclic antidepressants or serotonin and norepinephrine reuptake inhibitors
- Other interventions, such as gastric electrical stimulation or cognitive and behavioral therapy, may also be considered in certain cases, as mentioned in 1.
It's essential to note that the use of opioids, including morphine, is contraindicated in patients with gastroparesis, as stated in 1, and can lead to worsening of symptoms and increased risk of complications. Therefore, alternative treatment options should be prioritized to manage gastroparesis pain effectively and safely.
From the Research
Gastroparesis and Morphine Use
- Morphine is sometimes prescribed for pain control in patients with gastroparesis, but its use is associated with worse symptoms, delays in gastric emptying, and lower quality of life 2.
- A study found that 41% of patients with gastroparesis were taking opioids, with 82% of those taking potent agents like morphine, and abdominal pain was the reason for prescription for 61% of patients taking opioids 2.
- The use of potent opioids like morphine was associated with worse gastroparesis, nausea/vomiting, upper abdominal pain, and quality-of-life scores, and more hospitalizations compared with weaker opioids 2.
Potential Risks and Interactions
- The treatment of gastroparesis often involves the co-administration of several classes of pharmacological agents, which may lead to drug-drug interactions (DDIs) and undesired clinical outcomes 3.
- Many commonly prescribed combinations of medications for gastroparesis were predicted to cause potential DDIs, highlighting the need for careful consideration of medication interactions in patients with gastroparesis 3.
- None of the medications used for the treatment of gastroparesis, including opioids like morphine, are devoid of side effects, and the risk/benefit ratio should be considered when prescribing these medications 4.
Alternative Treatment Options
- Prokinetic agents, antiemetics, and other medications are available for the treatment of gastroparesis, but their efficacy is limited and may have side effects 5, 6.
- Novel therapies, such as 5-HT4 serotonin receptor agonists and dopamine D2 receptor antagonists, are being developed, but more research is needed to establish their efficacy 5.
- Other treatment options, such as gastric electric stimulation and injection of botulinum toxin into the pyloric sphincter, may be considered for patients with severe gastroparesis 6.