By Cheryl Ellis, Staff Writer
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
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
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
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.