Pruritus

The ability of morphine-like drugs to produce the sensation of itching (pruritus) is well known, and it is a discomforting complication when opioids are administered for therapeutic reasons. Further, many morphine-like drugs (e.g., codeine) release histamine from white blood cells that store it (mast cells and basophils). When morphine is administered intravenously, wheals (hives—raised red lumps) may appear at the site of the injection and along the course of the vein. The wheals may be associated with the sensation of itching. Occasionally, large doses of morphine may produce generalized itching. Rarely does morphine produce pulmonary edema (fluid in the air sacs of the lung), bronchoconstriction (narrowing of the air tubes in the lungs), or wheezing. With the advent of the use of intrathecal and epidural morphine (injection of morphine into spinal fluid or around the lining of the spinal canal) in pain management, the incidence of morphine-induced pruritus has become greater. Under this circumstance, the distribution of itching may be segmental (limited to the part of the spinal cord involved). Itching remains an elusive phenomenon and is harder to define and investigate than pain. It is thought that it may be mediated by a subgroup of nociceptive (pain-carrying) C fibers. Further, morphine s histamine-releasing property has been implicated in its ability to produce itching, as histamine does in allergic reactions.

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