Drugs treating severe pain

Paul L. Sacamano, Diane S. Aschenbrenner

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

• Pain is a subjective experience. Objective signs may or may not accompany pain. Lack of objective data does not mean that the pain is not present. • Pain, a complex physiologic phenomenon, is not clearly or completely understood at this time. • Pain is mediated through the CNS by nociceptors and perceived by the opiate receptors. When the opiate receptors are stimulated, perception of pain decreases. • Pain has many types or classifi cations, which are based on the pathophysiologic origin of the pain (nociceptive versus neuropathic), whether the pain refl ects a current injury or period of healing or extends beyond this time (acute versus chronic), or a subgroup of one of these classifi cations (visceral, somatic, cancer, or noncancer chronic). • Pain, to be treated appropriately, must be assessed with a pain assessment tool. Simply asking patients to rate their pain on a scale in their head is not the same as using an assessment tool. • Pain is best controlled when patients take analgesics before pain becomes severe and when doses are administered around the clock. • Doses of analgesics should be titrated to obtain maximum effi cacy with minimal adverse effects. • Nonanalgesics and nonpharmacologic methods of pain management may be used to supplement drug therapy. • Patients who have been receiving opioids for an extended period develop tolerance to the pain relief from the analgesics and need increased doses. Patients who abuse substances have cross-tolerance and need higher than expected doses to receive analgesia from drug therapy. • Morphine is the standard narcotic analgesic. It is an agonist at the opioid receptors. All other narcotics are compared with morphine to measure their effi cacy. Morphine is indicated in the treatment of moderate to severe pain. • In addition to analgesia, morphine, like all narcotics, produces a wide variety of other effects on the body. The most serious of these is respiratory depression, which if severe, can be life threatening. • The antidote to morphine overdosage and respiratory depression caused by any narcotic is naloxone, a narcotic antagonist. • Morphine, like all narcotics, is a controlled substance. By law, every dose must be properly accounted for and documented. This rule includes partial doses that may be wasted. • Relevant core patient variables are important to consider when providing morphine or other narcotics for pain control. The variables may alter the drug chosen, dose, frequency, route, patient's emotional response to pain, or frequency and depth of assessment made while the patient receives morphine or other narcotics. • Codeine is another narcotic analgesic used for mild to moderate pain. It is also used to suppress coughs. Its effects are similar to those of morphine, but usually milder. • Pentazocine, a different type of narcotic, is a combination of opioid agonists and opioid antagonists. Because of the antagonist effects at some receptors, it generally causes less respiratory depression than morphine and has less risk for inducing physical dependence. If given to a patient physically dependent on a narcotic, pentazocine may induce withdrawal. • Patients and their families need education about the importance of pain control and what will be done when they report pain. Moreover, they need to know that they are not expected to suffer. Discuss with them any fears or misconceptions about analgesic use and dispel such mistaken beliefs with facts. • Reassess patients for pain following changes in drug therapy, after every dose until a set dose controls pain, and periodically during the course of therapy.

Original languageEnglish (US)
Title of host publicationDrug Therapy in Nursing
PublisherWolters Kluwer Health Adis (ESP)
Pages403-430
Number of pages28
ISBN (Electronic)9781469819174
ISBN (Print)9781451187663
StatePublished - Nov 7 2012

ASJC Scopus subject areas

  • Nursing(all)

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  • Cite this

    Sacamano, P. L., & Aschenbrenner, D. S. (2012). Drugs treating severe pain. In Drug Therapy in Nursing (pp. 403-430). Wolters Kluwer Health Adis (ESP).