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Effective Pain Management
By Cheryl Ellis, Staff Writer
PAIN MANAGEMENT IS A SCIENCE
Over the decades, the perspective on
managing pain has widened. Healthcare
practitioners and patients have a closer relationship in
deciding pain management routes, incorporating “natural”
and prescribed medications and “alternative” methods of
Pain management was once considered
“doping up” the patient in some circles. Today’s
viewpoint incorporates consistent pain relief with
keeping the patient alert and functioning.
The variety of conditions that require
pain management has created a demand for an accurate
“science” to provide help based on condition and
individual need. The World Health Organization has
a “ladder” for managing cancer pain. Level One
uses non-steroidal anti-inflammatory medications (such
as aspirin) and “adjuvant”, or supplementary medications
that have a secondary effect of controlling pain by
eliminating a side effect. As pain increases with
cancer progression and/or treatment, professional
caregivers step to the next level of pain management.
By Level Three, opiates are incorporated and the
adjuvant medications are there to assist with opiate
OPIATES AND PAIN CONTROL
In the classic film “The Wizard of Oz”,
the Wicked Witch deters Dorothy and her friends by
creating a field of poppies they must walk through
before reaching the Emerald Castle. Dorothy and
the Lion fall asleep until the Good Witch intervenes
with snowflakes to wake them up, and the crew moves
toward their destination.
The poppy plant is used to create
opiates such as morphine and codeine, which relieve
pain, but also make the individual sleepy or lethargic.
The effects of “Opiates from Oz” are shorter lasting
than those administered for those in chronic pain.
Since alertness is a factor in complying with pain
medications, patients may be unwilling to try them,
looking to “natural” remedies instead.
The brain has receptors that recognize
both opiates and endorphins. Endorphins are “feel
good” chemicals produced naturally in the brain, and
have an analgesic effect. While they are
preferable to medications, both acute and chronic pain
sufferers may not produce sufficient quantities of
endorphins to dull or eradicate pain. Even simple
pain relievers like acetaminophen or aspirin may not do
the trick, and pain control must include opiates.
Morphine and its opiate cousins can be
given by mouth or intravenously. In some cases,
morphine can be delivered by a nebulizer, dispersing the
drug into an aerosol that can be inhaled. The
lungs also contain receptors for opoids, absorbing and
processing the medication.
Caregivers should be aware that any
medication delivered by nebulizer can disperse through
the room. Taking precautions when it comes to room
ventilation and proximity to the patient will help the
caregiver with unwanted exposure to medication.
The concern for precautions has less to
do with a “secondary high” for the caregiver than with
residuals of the medicine showing up in their urine if
The type of morphine nebulized is the
intravenous type without preservatives. When given
by aerosol, morphine can activate histamines and
constrict breathing passages. The goal of morphine
by aerosol is to alleviate difficult, painful breathing
rather than bring it on, so doctors may order an aerosol
treatment with medication to keep the airways open prior
to nebulized morphine.
There is a specialized, single dose
nebulizer that delivers morphine to the lungs. The
medication “strips” look very similar to the ones used
to test blood sugar, but contain the correct medication
dosage. Aerosol particles do not “fly” around
because of the design.