Pain Advisor

The
“Pain is whatever the experiencing person says it is, existing wherever and whenever the person says it does” M. McCaffrey

February 2013

Some Common Misconceptions About Opioids:

Truth: The opioids may appear to have stopped working

Myth: People who take when in reality, an increase in dose is needed. The most
Morphine will always common reason is that the disease is progressing and there is
need more and more a change in the level of pain experienced by the patient.
medication. Another reason is tolerance, which means that increasing
doses of medication are needed to achieve comfort for the
patient. Tolerance does not develop suddenly.

Myth: People who need

Truth: Just because a person needs an opioid medication (like
medications like
Morphine) to control their pain does not mean they are
Morphine for pain control
gravely ill or near death. Opioids are very effective
are always very ill and
medications that can be used at any stage in the disease
near death.

Truth: Opioids are not dangerous respiratory depressants when

Myth: Morphine is
used properly. Sedation and drowsiness always precede
dangerous because it
opioid induced respiratory depression. Titration of the opioid
can lead to respiratory
to manage symptoms and monitoring using the Opioid
depression.
Sedation Scale for drowsiness/sedation will prevent respiratory

Continued on Page 2
 Truth: Addiction is often confused with physical dependence.
Physical dependence is a normal physiological response to
Myth: Anyone who
long-term opioid therapy which manifests as withdrawal
takes Morphine or
symptoms when the opioid is abruptly discontinued or the
other opioids will
dose significantly reduced. Addiction is a psychological
become addicted.
craving for an opioid despite personal harm. A combination
of many factors including genetics, environment, and
behaviors can influence a person’s risk of addiction.

Myth: Side effects from Truth: Side effects such as nausea, itching, and drowsiness

taking opioids go usually do dissipate in 2-5 days, however, constipation does

away or dissipate in a not resolve with time. Prescribing opioids requires a pre-

few days. emptive care plan to avoid the distressing complication of

constipation.

Managing Constipation
Institute prophylactic measures for the treatment of constipation unless contraindicated, and monitor
closely for this side effect.

• Laxatives should be prescribed and increased as needed to achieve the desired effect as a
preventative measure for individuals receiving routine administration of opioids

• Osmotic laxatives soften stool and promote peristalsis and may be an effective alternative for
individuals who find it difficult to manage additional pills

• Stimulant laxatives my be contraindicated if there is impaction of stool. Enemas and suppositories

may be needed to clear the impaction before resuming oral stimulants

If ...

1. Suppository and fleet enema are ineffective ... repeat.

2. Still ineffective... high oil retention enema and high fleet.

3. Still ineffective ... soap suds enema (irritating and often poorly tolerated).

Important: Be sure to assess for bowel obstruction BEFORE initiating aggressive

laxative and enema administration. Such therapies are contraindicated in the presence of

bowel obstruction, except if obstruction is due to constipated stool