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 opioids, 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.

TOLERANCE IS NOT ADDICTION

Caregivers and loved ones may worry that tolerance means addiction, but they are not the same. Over extended periods of time, the dosage of the medication may need to be increased because the individual has developed a tolerance to the medication, or there has been a rise in pain levels.  Doctors work to use the lowest effective dosage to keep the patient alert and pain free.

Medication dependence occurs when there is a physical reliance on the medication and withdrawal symptoms (that are specific to the drug class) occur.  There may be tolerance present, but the withdrawal symptoms are noted if the medication is suddenly removed and/or levels of the medicine in the bloodstream decrease.  
When addiction is present, caregivers and medical personnel notice that the patient may “lose” prescriptions, and/or take their medications at inappropriate times.  A number of other behaviors may be present, including behavioral changes that include isolation from family members.

Rather than diagnose your family member, bring concerns to the family physician to evaluate the situation.  What seems like dependence or addiction may be the response to changes in pain level, tolerance or other factors that the doctor must evaluate.  Behavioral responses such as anger or depression may be due to poorly controlled pain, especially if the pain control journey is just beginning.

AIDS AND THE PAIN EXPERIENCE

With better medications and awareness on the part of doctors and patients, individuals diagnosed with AIDS are receiving improved care.  The pain experience varies from one person to another, even in the AIDS journey.

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