• nursing;
  • literature review;
  • palliative care;
  • pain;
  • morphine

Background.  No comprehensive review has been published to date, which provides information for nurses on pharmaceutical alternatives to morphine in palliative care. As nurses are often the health professional most involved with terminally ill patients, there is a clear need for a review of current practices which is accessible to nurses.

Aim.  The aim of this review is to examine the pharmaceutical alternatives to morphine use in palliative care that are currently available.

Methods.  Searches were made of the CINAHL and MEDLINE databases for articles published between 1990 and 2000, using the keywords ‘pain management’, ‘cancer pain’ and ‘morphine’.

Findings.  Most evidence on the use of pharmaceutical alternatives to morphine is anecdotal, demonstrating a need for more research to be conducted in this field. Evidence presented in this review shows encouraging results following the administration of methadone, fentanyl or ketamine to patients with difficult pain problems.

Conclusion.  Nurses need to be aware of treatment options that may benefit patients with difficult pain problems. Although positive experiences have been documented when using alternatives to morphine, more research must be conducted to allow practitioners to add more pharmaceutical alternatives to their pain management armouries.