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Effective Pain Management

By Cheryl Ellis, Staff Writer
(Page 2 of 5)


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 relief.

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 side effects.


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 drug tested.

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.

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