Pain : Addiction and Chronic Pain
Posted by Chapster on Mar-01-2005 (2187 reads)

Those of us who work with the chronically and terminally ill find ourselves constantly struggling to clarify confusion about pain medication. It is felt by many that opioids, such as morphine, should be avoided, at best, and are the crutches of druggies at worst. Enter this excellent article that describes four myths concerning the use of opioids.

The article, by Jennifer P. Schneider, MD, PhD, does a good job of debunking the belief that opioids create addiction in settings where true chronic pain exists. Quote:

They are the most effective pain relievers we have.

We feel the article would be very helpful for professionals seeking to help patients (and families, long term care staffs, etc) to allow pain to be treated more aggressively.

As the title suggests, the article deals primarily with chronic pain. As ElderHope deals mostly with terminal illness, we would like to emphasize that opioids also have tremendous value to those who are dying. Even for these patients we occasionally find patients and families who resist opioids for the same reasons. Additionally, they resist pain medications because they are sedating (especially in the early stages of usage) and because they depress the respiratory system.

The failure, though, to use these medications often has the effect of allowing the patient to be in unnnecessary and extreme pain. The relief of the pain often allows patients to actually enjoy life more, and to be able to participate more pleasurably. Indeed, sometimes, after the initial introduction of opioids, the sedative effects may wear off.

One other aspect in which opioids are especially helpful, paradoxically enough, is in situations where patients have breathing difficulties, such as patients who have very late stage Chronic Obstructive Pulmonary Syndrome (COPD). The very opioid effect that we mentioned in a previous paragraph, depression of the respiratory system, in a sense comes to the rescue of patients for whom breathing is difficult. Using medications such as morphine, the respiratory system is relaxed and the breathing that takes place is threfore more relaxed and the body is less likely to go into panic mode, attempting to breath.

We hope you'll read (and for professionals, use) the article we site here and the other links referenced at the end of this ElderHope article.

Additional Resources
Dyspnea from Palliative Care Perspectives
Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease.
Nebulized Morphine for Terminal Dyspnea: A treatment option
An approach to dyspnea in advanced disease
Symptom Management Strategies for Dying Patients

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