Does A Morphine Pump Induce The Patient To Sleep?

Posted on Thu, 10 Mar 2016

Question: My brother in law has terminal mouth cancer. He had his jaw removed and put back in, he had radiation and he had chemo, but in September they told him they could not help him anymore. He has huge tumors inside his mouth, on his lips, on his chin and they grow more every day. We are keeping his pain managed with morphine applied directly on the tumors every hour. He is 6'2" and his weight is down to 138. He stays nourished using a turkey baster. Some days he stays up and works at his computer or watches TV, and some days, he just sleeps all day in his chair. He is on Hospice and they are installing a morphine pump on Monday because sometimes he cannot get his mouth open wide enough for us to put the morphine drops on his tumors. My question is whether the morphine pump will cause him to sleep all the time now, and will he just fall asleep one day and not wake up, or can he live a long time like this? The doctors just do not want to give us any kind of a time line as to his life expectancy, or explain what he death might look like. Will the tumors get so big that he cannot breathe? Will the cancer spread to other parts of his body? Will his organs just shut down? Will he just go into a coma and die in his sleep? We would like to plan our vacation days in such a way that one of his family members will always be with him, but it is hard to know how to do that because we don't know if he has days, weeks, months, or years left. We don't want to use up all our vacation time prematurely, and then not have any time left when he really needs us. How will we know when the time is close?

Answered by Dr. Dr. Matt Wachsman (4 hours later)

Brief Answer:
Cannot say with absolute precision.

Detailed Answer:
The morphine level is adjustable. And pumping it up to potentially fatal levels is standard medical practice. Having uncontrolled pain is generally not preferable.

This cancer spreads by direct termite creeping, not by metastasis in general. Loss of weight and cancer erosion leads to infection. While mostly infections can be treated, people often opt to NOT treat them and then someone has fever, loss of blood pressure and a rapid downhill course. When this occurs is unpredictable.

The cancer can erode into a major blood vessel and this is not treatable except sometimes by the most heroic extreme measures with temporary effect. It is generally not indicated to do treatment for it.

The organs by themselves will not shut down. Infection, blood loss, or excessive morphine will shut them down.

So.... unless the morphine overdoses, which is not necessary nor recommended nor likely, a catastrophic event will occur and the timing of it is not predictable. It is the shape of any other failure curve, like lightbulbs, corn popping and car repairs. You have a few disasters right at the beginning, then a long period where not much happens, then increasing numbers at an average time period and a few stragglers out from the average. Without being there, I can only make a guess at the number, the estimate is in weeks not months nor years. but whether that is 2-3 weeks or 20 to 30 weeks I cannot say unless there. My guess is 2-3 months.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar