Epinephrine vs. Morphine in end-of-life care

So, I guess my question is pretty straightforward: in cases where someone is dealing with massive pain even while they're on morphine (like at the end stages of cancer), why isn't adrenaline used? I get that adrenaline can be really hard on the heart, liver, muscles, and all that, but if I'm going to pass away in two weeks anyway, why not just go for it? From what I understand, adrenaline is such a powerful drug that it could basically wipe out any sense of fear or pain entirely. Wouldn't it be better to die without that pain and fear rather than being stuck in agony and losing consciousness? Isn't it more humane to at least be able to have a decent conversation? Could patients (in situations like this) actually ask for adrenaline injections?

Kyle Gray43 said:So, my question is pretty straightforward: when someone is in massive pain—even with morphine running through them (usually at the end stages of cancer)—why isn't adrenaline used? I get that adrenaline can wreck your heart, liver, muscles, and all that, but if I’m going to die in two weeks anyway, why not just use it? From what I know, it's an incredibly powerful drug that could basically wipe out fear and pain entirely. Isn't it better to pass away without the agony and the panic? Wouldn't it be more humane to actually be able to hold a decent conversation? Could patients in those situations even request adrenaline injections?

Kyle Gray43, where can I find info on adrenaline? How do you actually know? Like, where can I verify this stuff about adrenaline causing damage? I've had to take an adrenaline shot twice because of anaphylaxis, so I'm curious. Thanks for the help, LP, Rachel Davis32

Rachel Davis32 said:I've actually had to use an EpiPen twice because of anaphylaxis, so I'm curious about this.

I've been there too—had to use it twice. Was it a bee sting that triggered it? 🙂

I’m not quite sure where you’re getting your data, but that source is anything but reliable... Adrenaline doesn't actually function as an analgesic, which means there is no clinical benefit to administering it for terminal cases or any other painful conditions... It is primarily used as a vasoconstrictor and, very rarely, as a bronchodilator...
And to all you anaphylaxis enthusiasts, what exactly are we discussing here?
By the way, I also have firsthand experience with adrenaline during anaphylactic shock, though I was on the receiving end... I would be interested to hear about your experiences if you've encountered any unique side effects from the medication...

It wasn't a bee sting for me; I actually had a reaction to the medication during my immunotherapy sessions. That’s why I had to stop. I wrote a little bit about it here:

And I wrote more about what that reaction actually felt like on my own blog here:

http://mmambaa.blogspot.com/2007/05/...oterapije.html

The night I had my first anaphylactic episode, and again when I tried to continue the therapy, my doctors were really worried about whether it was safe to proceed. I guess there are definitely side effects to all this stuff. I ended up getting an adrenaline shot in the muscle along with some systemic antihistamines.

Honestly, it's wild how powerful either the adrenaline alone or that whole cocktail of meds was. My body went from bright red and blotchy back to looking totally normal within minutes. My blood pressure stabilized too, and the wheezing and coughing stopped.

I just thought, "man, chemistry is amazing." And I don't mean that like, "yay, drugs!" But I didn't really consider that adrenaline might have a downside. I'll admit I searched everything I could online, but I didn't go to a library. I doubt I would've understood much anyway if the books were too technical.

I'm wondering, though, what are the downsides to adrenaline? My experience was this sudden, miraculous improvement mixed with heart palpitations, but they told me you can get that from using an Albuterol inhaler too (like five times).

Both albuterol and epinephrine act on the sympathetic nervous system, which can lead to negative side effects. However, there is no need to worry about the epinephrine specifically; those adverse effects typically arise from chronic use or from receiving single, high-dose administrations. This primarily manifests as hypertension and its various complications, along with significant vasoconstriction, which can reduce oxygen delivery and potentially lead to a myocardial infarction.

I mean, I know when people are under massive stress, that adrenaline surge gives them this crazy strength boost because their bodies are basically burning through simple sugars like crazy. I also know stories from combat zones where soldiers have had limbs torn off and didn't even notice or feel a thing in the moment. Up until now, everyone’s just chalked it all up to adrenaline. But if it isn't just the adrenaline, then what the hell is it?

@ Rachel Davis32 If that's actually you in the photo, just so you know, you look incredible.

Adrenaline actually has a very specific physiological job—it hits at certain times, works in certain ways, and targets specific areas. It even has its own therapeutic uses, but treating pain definitely isn't one of them. When you’re talking about acute stress and pain management, there are way too many moving parts involved. It's pretty naive to give adrenaline credit for things it just doesn't do. Honestly, bringing this up pushes the limits of what we should be debating on a forum like this, because you really need a solid grasp of human physiology to get it—stuff like blood sugar levels, blood flow redirection, cytokines, the sympathetic nervous system, endorphins, serotonin, and various neuromodulators.

Honestly, adrenaline and morphine are just two completely different worlds, they don't have anything to do with each other

Adrenaline essentially triggers a total body spray of hormones whenever you hit an emergency situation. Regarding the phenomenon where people don't seem to notice broken limbs or deep cuts—it's the nervous system at work. Neurons can release substances that act as natural analgesics. It all boils down to what was mentioned earlier: more energy, less pain.

And what trebor said is spot on—listen to him, the guy really knows his stuff. 🙂